Job is Expired
Location: Alabama, Alaska, Arizona, Arkansas, California, Idaho, Illinois, Iowa, Kansas, Louisiana, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Utah, Washington, Wisconsin
Compensation: To Be Discussed
Staff Reviewed: Tue, Jun 22, 2021
Job Summary
A privately held healthcare technology solutions company is filling a position for a Remote Licensed Utilization Review RN.
Core Responsibilities of this position include:
- Performing initial, concurrent, and/or retrospective review of services that require prior authorization or medical appropriateness review
- Documenting clinical appropriateness reviews and care management activities in managed care operating Systems
- Facilitating cost effective and quality patient care by effective communication with physicians, providers and members
Skills and Requirements Include:
- Minimum of 3-5 years of clinical experience
- One year of care management, utilization management experience, clinical documentation or clinical auditing experience
- Successful work history in a clinical setting and/or health insurance environment
- Being a Registered Nurse with an active nursing license to practice in the state of the contracted Client (i.e. Florida, Arizona etc.).
- Knowledge of medical appropriateness criteria such as InterQual®, Milliman Care Guidelines®, or eviCore healthcare
- Knowledge of CPT, ICD-10, and/or HCPCS codes or coding experience
