RN Utilization Review Nurse
- Hidalgo, TX
What you'll be doing
- As a rn utilization review nurse, the candidate will manage concurrent, retrospective and discharge reviews for observation, acute, snf, rehab and long term acute care admissions. Apply a set of specific evidence based medical standards and associated clinical procedures and ensures compliance with these standards for different types of clinical environments. Possess a strong working knowledge of all acute and post acute levels of care. Possess knowledge of healthcare practices and policies. Interpret clinically and criteria and communicates effectively in a verbal and written manner with facility cm, sw, attending and health plan medical directors about members needs and barriers. Work directly with the ipa, inpatient manager, ipa medical directors related to specific ipa goals and opportunities. Communicate and interact with ipa administrators and a provider representative to address ipa specific opportunities in a timely manner.
What your background should be
- Registered nurse with current licensure, 3 to 5 years experience utilization review experience required. Strong computer skills are preferred.
Required Schooling / Training
- Not specified
Who is the client company
- This is a global health insurance service company.
- If you are interested in this position, send your resume to email@example.com