Utilization Review Nurse – RN
Oklahoma City, Oklahoma
Intro:
Are you an experienced Registered Nurse with Utilization Review experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes” to any of these questions – this is the position for you!
Position Summary:
Conducts utilization management activities in accordance with Utilization Management policies and procedures. Responds to calls, conducts certification reviews, facilitates the discharge planning and referral process and coordinates denials with physician advisors for all assigned programs.
Pay Range: $30-32/HR
Hours for this Position: Monday – Friday 8:00am- 5:00pm
Contract Period: 6 month contract with a possibility of going longer
Advantages of this Opportunity:
- Competitive salary
- Fun and positive work environment
Required Skills
What We Look For:
- Unrestricted active RN license in their state
- Utilization Management experience
- Prior Authorization experience
- Computer literate. This includes simultaneous use of multiple programs and applications; navigating varied file formats; performing copy/paste, save, and update information in multiple formats.
Responsibilities
More Insight of Daily Responsibilities:
1.Receives prospective & concurrent requests for service. Coordinates certification reviews for pre-admission, continued stay and retroactive reviews. Interprets and applies clinical information to make delivery decisions and determine appropriate level of care for utilization review activities. (50%)
2.Follows departmental policies & procedures for review, determination & notification. Ensures day to day UM processes are conducted in accordance with NCQA, URAC and other regulatory standards. (15%)
3.Maintains effective interactions/communication w/ outside providers to assure appropriate delivery of service to members. (10%)
4.Reviews requests for medical necessity (referring cases to medical director that require additional expertise). Coordinate denials with physician advisors (10%)
5.Documents all activities per APS policies and procedures. (15%)
Want More Information?
Interested in hearing more about this great opportunity? Reach out to Marjorie Mora, Recruiting Consultant at marjorie@healthcaresupport.com for immediate consideration.
Why You Should Work For Us:
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
V2014
Salary
Based on experience