Utilization Management Nurse (RN / LPN)

The Execu|Search Group
Aug 13, 2017
Aug 14, 2017
Employer Type
Direct Employer
Employment Type
Full Time
Job Description:

About the Opportunity A New York City-based healthcare company is currently looking for a licensed Registered Nurse (RN) and/or Licensed Practical Nurse (LPN) for a promising Utilization Management Nurse position with their growing team. In this role, the Utilization Management Nurse (RN / LPN) will be responsible for performing the review of requests for service authorizations in order to monitor continuity and coordination of care and to assist in the utilization of appropriate services. Apply today! Company Description Healthcare Company Job Description The Utilization Management Nurse (RN / LPN) will be responsible for: * Assisting in the prospective review process by pre-screening referral forms for adequate information * Obtaining necessary documentation for a determination to be rendered * Respond into emergent and expedited / urgent authorization request with priority and timely/referral turnaround time * Referring cases for which criteria are not met to the Medical Director when unable to resolve within contracted timeframe * Serving as a liaison between the Medical Director, Physicians and office staff in resolving prior authorization questions, issues and problems * Assuring medical management adherence to company and department policies and procedures regarding confidentiality * Performing evaluation and concurrent monitoring of appropriate utilization of durable medical equipment, hospitalizations, home healthcare, infusion services and long-term rehabilitation Required Skills * 1+ year of Utilization Review / Case Management experience; 1+ year of Clinical experience in the Healthcare field * Associate's Degree in Nursing * NYS Registered Nurse (RN) license and/or Licensed Practical Nurse (LPN) * Knowledge of InterQual Criteria, Florida Medicaid Program, and CMS Guidelines * Previous experience in an Inpatient and/or Outpatient setting * Solid assessment, clinical, and documentation skills * Patient oriented * Great interpersonal skills * Excellent communication skills (written and verbal) * Strong attention to detail * Highly organized * Able to multitask efficiently and effectively Desired Skills * Bachelor's Degree in Nursing