Telephonic Utilization Management Nurse


Birmingham, AL

What you'll be doing

Performing utilization management, utilization review, or concurrent review using milliman criteria. Determining medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Assessing and interpret customer needs and requirements. Identifying solutions to non-standard requests and problems. Working with minimal guidance; seeks guidance on only the most complex tasks. Translate concepts into practice. Providing explanations and information to others on difficult issues. Coaching, providing feedback, and guiding others. Acting as a resource for others with less experience. Conduct clinical chart assessments. Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care. Participate in rounds with the medical director and discussing cases as needed. Determine need, if any, for intervention, and discussing with case managers and physicians. Identify and evaluate delays in care. Initiate a discharge planning and readmission prevention plan. Approve bed days for inpatient cases. Arrange alternative care services; contact and maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum. Gather clinical information to assess and expedite care needs.

What your background should be

Minimum 3 years of nursing experience in a hospital or in an inpatient acute care setting. Active and unrestricted RN license in state of residence. Intermediate computer skills, Microsoft word, with the ability to navigate a Windows environment, must be able to handle multiple systems. Excellent verbal and written communication skills. Strong typing skills.

Required Schooling / Training

Undergraduate degree

Who is the client company

Concern about healthcare services.
If you are interested in this position, send your resume to