What are the responsibilities and job description for the Utilization Review Nurse position at The Judge Group?
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
