Utilization Management Nurse (Um Nurse) Thurs-Sun Shift

Job Summary:

As a Utilization Management Nurse, you apply your clinical knowledge to review criteria/medical guidelines (i.e. plan policy, MCG, Interqual, CMS...) and accompanying medical records in order to render determinations. You will communicate with physician reviewers to ensure all questions posed have been addressed, and to ensure that cases are returned within client deadlines. All reviews that do not meet the criteria will be addressed with the physician reviewer for potential adverse determination.

Shift Available:

• Thurs-Sunday (10 hour shifts)

Core Duties & Responsibilities:

Evaluates the medical records and policy/criteria for medical necessity reviews

Reviews cases with the physician reviewer for cases that do not meet medical necessity guidelines for potential adverse determinations.

Read & apply policy guidelines, healthcare terminology and delineate when criteria is/is not met.

Provides strong customer service skills and works closely with the client on a case-by-case basis to provide complete, timely and error-free reviews

Provides clinical oversight to cases that are complex and need additional review prior to return to the client.

PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Requirements

Required Education & Experience:

• Must be a graduate of an accredited LPN, LVN or RN program.
• RN highly preferred
• Utilization Management experience is required.
• Experience working in a remote environment is preferred.
• Experience in a medical office or health care background.

Required Skills:

• Must work with a sense of urgency and meet deadlines.
• Must be self-motivated, with a strong drive for performance excellence.
• Excellent written and verbal communication skills are required.
• Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus).
• Attention to detail REQUIRED.