The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.
Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways.
Our PRN Nursing Program is designed for flexible, as-needed staffing to support our team during peak times, weekends, and holidays.
Major Duties & Responsibilities
Requirements
Additional Duties
Education/Credentials:
Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.
Job Relevant Experience:
2 yrs minimum clinical nursing experience is required.
One year of previous experience in Utilization Management is required.
Job Related Skills/Competencies:
Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.
Working Conditions/Physical Demands:
Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.
Work From Home Technical Requirements:
Supply and support their own internet services.
Maintaining an uninterrupted internet connection is a requirement of all work from home position.
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