Job Summary
We have an immediate need for an experienced Registered Nurse (RN) with at least two years of Behavioral Health Utilization Management experience.
The right candidate will have the ability to review retrospective, prospective, and concurrent review. The Clinical Review Nurse supports health plan operations to ensure delivery of medically necessary, appropriate, timely, cost-effective and quality health care services.
This immediate opening is a temporary, telecommuting position lasting six (6) months; Hours Monday - Friday 8:30 am - 5 pm MST.
Qualification
Position requirements:
2 years of Behavioral Health Utilization Management Experience
Three years of utilization management or discharge planning
Clinical experience in medical/surgical or specialty care
Knowledge of managed care information systems, and clinical criteria
Independent decision making
Knowledge of quality improvement
Excellent verbal and written communication skills
Orientation to detail
Ability to work under tight timelines
Coding experience preferred
Educational requirements:
Graduate of an accredited school of nursing
Licensure
Licensure
Active unrestricted RN license in the State of residence, compact eligible