US Tech Solutions
Quality Management Nurse Consultant
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Job Description
- Req#: 24-06272
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive salary based on experience
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and clinical outcomes
- Work with advanced clinical systems like Medcompass
- Engage in meaningful work that adheres to regulatory and accreditation standards
What to Expect (Job Responsibilities):
- Review and evaluate clinical information and documentation for compliance with clinical policies and regulations
- Independently coordinate clinical resolutions with internal and external clinician support as needed
- Gather and navigate data through multiple system applications to develop determinations or recommendations
- Contact providers, vendors, or internal departments to obtain additional information for case reviews
- Accurately apply review requirements to ensure each case is handled by a qualified practitioner
What is Required (Qualifications):
- Minimum of 3 years of clinical experience
- RN with current unrestricted state licensure
- Experience with Medcompass and prior authorization utilization
- Knowledge of Managed Care and Medicare/Medicaid
- 1 year of Utilization Management experience, preferably with knowledge of Milliman/MCG
How to Stand Out (Preferred Qualifications):
- Managed Care/Medicare experience
- 6 months of Prior Authorization experience
- Familiarity with inpatient utilization management reviews
#HealthcareServices #ClinicalEvaluation #CareerOpportunity #RegulatoryCompliance #UtilizationManagement
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Our Talent Your Results - This is the premise behind US Tech Solutions. Our flexible engagement model offers right-fit talent on-demand - when, where and how you need it, so you can achieve your business objectives. We offer contingent, contract-to-hire or direct staffing services. At USTECH, we understand how critical talent is to every organization, as well as how the world of work and the workplace is changing. We offer the most effective means to help you acquire, manage and optimize talent. USTECH was founded in 2000 by Manoj Agarwal. Today, we are a global firm offering talent solutions to 150 customers including 20% of Fortune 500 across Financial Services, Healthcare, Life Sciences, Aerospace, Energy, Retail, Telecom, Technology, Manufacturing, and Engineering.
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