Base: $24.00 - $38.50; bonus/equity: not specified...
Medical necessity reviews
Utilization management activities
Conduct level of care reviews
Join the Health Plan Utilization Management team and leverage your RN expertise to conduct medical necessity reviews to ensure members receive appropriate, high-quality care
Job Summary
Join the Health Plan Utilization Management team and leverage your RN expertise to conduct medical necessity reviews to ensure members receive appropriate, high-quality care.
Performs utilization management (UM) activities in accordance with UM plan to assure compliance with accreditation/regulatory requirements.
Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization.
Matching Summary
Join the Health Plan Utilization Management team and leverage your RN expertise to conduct medical necessity reviews to ensure members receive appropriate, high-quality care.
Salary
Base: $24.00 - $38.50; Bonus/Equity: Not specified; Benefits: Not specified
Skills & Requirements
Must-have
Medical necessity reviews
Utilization management activities
Conduct level of care reviews
Insurance coverage and denials
Prior authorizations
InterQual clinical decision support criteria
Nice-to-have
Dynamic and tactful interpersonal skills
Collaborating with healthcare team
Promote medically necessary resource utilization
Flexibility and adaptability
Key Requirements
Registered nurse (RN) license
Bachelor's degree in nursing preferred
Graduate from nationally accredited nursing program