Job Summary
A professional services firm specializing in IT, healthcare, and accounting is in need of a Remote New York Licensed Inpatient Utilization Management Nurse.
Candidates will be responsible for the following:
- Performing concurrent reviews of inpatient and inpatient sub-acute claims
- Identifying solutions to problems and non-standard requests
- Performing prior authorization reviews for outpatient services
Skills and Requirements Include:
- Current unencumbered RN license in New York
- Demonstrated knowledge of and proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria
- 5+ years of acute clinical experience and 2+ years of utilization management experience
- Utilization management for Medicare Advantage, Managed Medicaid, Dual SNP, & Commercial Lines of Business
- Strong knowledge of utilization management processes, standards, and an understanding of managed care
- The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families
