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Utilization Review Nurse
- Posted: September 06, 2024
- Salary:US$40. - US$47. per hour + full benefits package
- Location:Washington
- Job type: Permanent
- Discipline:Care Management
- Reference:233734_1725671877
- Work Location:Hybrid
Job description
We are looking for a Registered Nurse experienced in Utilization Review, looking to work within a diverse population.
Some responsibilities include...
- Assessing patient care, review medical records and care plans to make sure that treatments are necessary and effective. Evaluating how well resources are being used.
- Deciding on coverage, determining if patient's healthcare insurance will cover specific care. Walk patients through their insurance options and limitations.
- Collaborate with insurance companies, social work, and quality improvement teams
- Making recommendations
- Help determine how long a patient should stay in the hospital, and if the care plan is effective.
- Evaluating clinical appeals, assess patient care services in clinical appeals to decide if they should be approved or denied
- Looking at 15 cases a day, Pediatrics as well as adults form 18-25 of age
Looking for indivduals with...
- Health plan experience
- Hospital experience
- Interqual or Miliman experience
- Experience in health plans reviews (dermal medicine, home health, rehab)
- Pediatric inpatient admissions is a plus
- Authorization, long term care, skilled nursing, behavioral analysis is a plus
Training in person. After training, the obligation is one day per week in the office based on the employees decision to select.
Monday-Friday full time role
8:00-5:00pm