Looking for Utilization Management Nurse for Busy Medical Group
Some key responsibilities Include:
- Assist in the prospective review process by screening referrals for adequate information, approving specific referrals according to policy and procedure, and serving as a resource to the staff and for utilization management related issues.
- Provide concurrent monitoring, tracking and authorization of ongoing outpatient services, i.e. home health, DME, IV therapy and supplies for appropriateness and medical necessity.
- Documentation of retrospective review of unauthorized claims/services for payment based upon reasonable criteria developed and approved.
- Service as a liaison between Utilization Management and Quality Management Departments to report all quality of care issues.
Job Type: Full-time
Pay: From $31.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Standard shift:
Supplemental schedule:
Weekly schedule:
Work Location: In person