Job Summary
A healthcare staffing and recruiting firm has an open position for a Remote Healthcare Utilization Review Nurse in Baton Rouge.
Candidates will be responsible for the following:
- Being responsible for utilization management and utilization review
- Performing reviews of services and determine medical appropriateness of inpatient and outpatient services
- Obtaining the information necessary to assess a member's clinical condition
Applicants must meet the following qualifications:
- LA RN License Required
- 2 years acute care clinical nursing experience is required
- 1 year of recent experience in Utilization Review or Utilization Management
- Knowledge of guidelines for Medicaid/Medicare and related state programs is required
- Experience using Milliman or InterQual criteria for medical necessity, setting and level of care, and concurrent patient management
- Computer skills to include Microsoft Word, Excel, database use, and basic data entry
