Job Summary
A professional employment agency and recruiting service is searching for a person to fill their position for a Remote Utilization Management RN or LPN LVN in Columbus.
Core Responsibilities of this position include:
- Providing high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary
- Assisting in determining appropriateness, quality and medical necessity of referral requests using pre-established guidelines
- Functioning as a clinical resource for other staff in the company such as utilization review, patient services, disease management, and sales
Qualifications for this position include:
- Active and Unrestricted LPN or RN licensure
- Utilization Management (UM) experience
- Demonstrated strong knowledge nursing requirements in a clinical setting
- Demonstrated knowledge of utilization management programs as related to pre-set protocols and criteria
- Proven knowledge of health plans
- Ability to read and interpret benefit contract specifications
