Utilization Review Nurse

Judge Healthcare is looking for remote Utilization Management RNs!

Contact: 3 months

Schedule: Monday-Friday, no nights/weekends

Location: Remote

Pay: $40.00 per hour

Responsibilities:

• Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family.
• Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.
• Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.
• Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
• Provides clinical assessments, health education, and utilization management to members.
• Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
• Manages own caseload and coordinates all assigned cases.
• Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members.
• Tasks involve a degree of forward planning and anticipation of needs/issues.
• Resolves non-routine issues escalated from more junior team members. RN and current unrestricted nursing license required.

Qualifications:

• Active RN license
• Health Plan experience required
• 2 years utilization management RN experience required
• Experience with prior authorization, concurrent review and medical necessity reviews
• MCG or InterQual experience required

If you meet these qualifications and are interested in this opportunity, please apply directly with an updated resume.