Judge Group

Utilization Review RN

ID: 629589

Type: Contract

Location: REMOTE

Salary: Open

Our client is currently seeking a Utilization Review Nurse to join their growing team!

This job will have the following responsibilities:

  • Conduct pre and post-payment review of inpatient admissions, outpatient services, and other procedures to assess the appropriateness and continuity of care.
  • Apply all aspects of the medical review function, including pre-authorization, concurrent review, screening for quality of care issues, and discharge planning. Document rationale for medical decisions made.
  • Identify at-risk members who would benefit from health management programs through comprehensive health assessments.
  • Monitor and evaluate patient’s plan of care and identify potential issues through telephonic outreach. Recommend appropriate interventions.
  • Promote member and provider satisfaction.
  • Provide continuity and consistency of care by building positive relationships between member and family, physicians, provider, care coordinator, and health care plan.
  • Represent Plan in a responsible and professional manner.
  • Participate in department initiatives and projects.
  • Perform other duties as assigned.

Qualifications & Requirements:

  • Valid, Unrestricted RN License
  • 3-5 Years Utilization experience
  • Previous clinical LTACH, Rehab or Step-Down Unit experience preferred