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Utilization Management Specialist (RN required), PRN - REMOTE
This job is now closed
Job Description
- Req#: R-27044
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive employee benefits, including affordable health plan options and dental/vision plans
- Paid time off (flex PTO) and tuition reimbursement available
- Supportive and inclusive work environment that values diversity
- Chance to make a positive impact on patient care and wellness
What to Expect (Job Responsibilities):
- Facilitate optimal reimbursement through accurate certification and complete chart documentation
- Conduct initial admission assessments based on utilization review medical necessity criteria
- Collaborate with multidisciplinary team members to ensure appropriate patient care levels
- Participate in denial processes and facilitate patient throughput from the emergency department
- Refer cases for secondary review when necessary
What is Required (Qualifications):
- Bachelor’s degree in a relevant field
- Minimum of 1 year of relevant work experience
- Licensure as a Registered Nurse
- Knowledge of medical terminology and documentation
- Proficiency in utilization review and clinical applications systems
How to Stand Out (Preferred Qualifications):
- Experience in interdisciplinary education and collaboration within healthcare settings
- Familiarity with InterQual Level of Care Criteria and Milliman Care Guidelines
- Strong problem-solving skills and ability to analyze complex issues in healthcare
- Experience providing education and training to team members
#HealthcareServices #PatientCare #CareerOpportunity #DiversityandInclusion #UtilizationReview
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