Demo

Utilization Review Nurse

The Judge Group
Bloomfield, CT Contractor
POSTED ON 2/17/2025
AVAILABLE BEFORE 3/15/2025

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.

Salary : $40

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