Utilization Management Nurse

Looking to add a UM nurse to our team. Would like this position to start as soon as possible. MUST HAVE have Concurrent Review Experience, preferably from the health plan side, and even better for a Medicare Advantage Plan.

Duties:
Conduct telephonic reviews for inpatient facilities for both concurrent and retrospective reviews
Process Prior Authorization requests for medical necessity of Outpatient services
Gather clinical information to assess and expedite care needs
Collaborate with providers to assess members, needs for early identification of and proactive planning for discharge, transfer and redirection
Identify problems or needed changes, recommends resolution, and participates in quality improvement efforts
MUST know this is a growing health plan, they have around 900 members now and it is a start up that will have growing pains. Must be ok with flexibility/change- but there is opportuntiy for growth.

Must Have Skills/Qualifications:
Active RN License (Must be Multi-state include AZ and FL)
1-3 years' experience in Concurrent Review
1+ years working with a healthplan
2+ years of UM Nurse experience
Must have their own equipment (laptop/computer and headset)

Nice to Have Skills:
Medicare Advantage experience
Bilingual in Spanish
Experience with ESRD and/or dialysis
Familiarity with Medicare Guidelines and MCG

Schedule/Shift:
Monday-Friday 8AM-5PM (AZ MST)

Benefits/Perks:
Base pay + along with competitive benefits for yourself and your family
Incredible growth opportunities with an actively growing start up
Top-notch training to keep you educated, informed, and up to date with industry trends
Regular one on one coaching and mentoring from Managers to improve your craft and reach your goals
Clarity and collaboration
Medicare based plan for renal disease
5 plans and one MA plan
GROWTH

Pay: $36.94-$42.00/hr DOE

Medix is acting as an Employment Agency in relation to this vacancy.