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Utilization Review RN

Expired Job

Carenational Washington , DC 20003

Posted 1 week ago

Utilization Review RN - Managed Care
Washington, DC
This is a full-time, benefits available, CONTRACT opportunity, expected to last 2-3 months, or longer!

Utilization
Review Nurse

Job Summary:

  • The Utilization Review Nurse is responsible for utilization management and utilization review for prospective (prior authorization), concurrent, or retrospective review.
  • The Utilization Review Nurse will performs reviews of services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
  • Utilize clinical skills to telephonically provide and facilitate utilization review, continued stay reviews and utilization management of all cases based on clinical experience and recognized guidelines.
  • The Utilization Review Nurse will obtain the information necessary to assess a member's clinical condition, identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs.
Utilization Review Nurse Background:
  • Current, valid, and unrestricted state Registered Nurse (R.N.)license.
  • Bachelor degree and/or a CCM or CPHM /CPUM/CPUR or similar certification is preferred
  • At least 3years of acute care clinical nursing experience is required.
  • Requires 1-2 years of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization (HMO/TPA/IPA/etc).
  • Knowledge of guidelines for Medicaid 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.
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Participates in quality improvement and evaluation processes related to the management of care. :: Education/Qualification * Registered Nurse, BSN required * Current licensure in the District of Columbia required * Case Management Certification preferred Skills * Effective oral and written communication and interpersonal skills * Knowledge of government and third party reimbursement systems and contracts. * Strong organizational and problem solving skills * Ability to maintain confidentiality Ability to adapt to multiple and changing priorities This opportunity offers the following: * Challenging and rewarding work environment * Growth and Development Opportunities within UHS and its Subsidiaries * Competitive Compensation * Excellent Medical, Dental, Vision and Prescription Drug Plan * 401k plan with company match One of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the World's Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies. Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve. Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom. * UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to "UHS or UHS facilities" on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. 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Utilization Review RN

Expired Job

Carenational