Utilization Management Nurse
Location: Birmingham Alabama!
Description: NaphCare, Inc. is in need of Utilization Management Nurse right now, this job will be placed in Alabama. Detailed specification about this job opportunity please give attention to these descriptions. Position Summary:
The Utilization Management Nurse performs technical and administrative work required to evaluate the necessity, appropriateness and efficiency of the use of medical services, procedures and facilities. The UM Nurse has an emphasis on the review, analysis, monitoring, and operation of the patient medical care plans.
Position Requirements:
A current and unrestricted RN license in the state of employment, with a minimum of 3 years’ experience in an acute care setting and 2 years’ experience in utilization review and/or case management! . Excellent communication and interpersonal skills, attention ! to detail and decision-making skills are essential. BSN and familiarity with Milliman Care Guidelines preferred.
Performance Expectations:
Understanding of the principles and concepts of medical quality assurance and utilization review.
Develop, implement, and administer the quality assurance and utilization review processes.
Monitor and report on the quality of all facets of the medical care provided to patients.
Perform utilization and concurrent review of patient cases.
Conduct detailed clinical chart assessments.
Gather clinical information to assess and expedite care needs.
Determine need, if any, for intervention, and discussing with physicians.
Reviews requests from providers regarding medical necessity of requested services for patients.
Reviews and audits patients' medical records as indicated to determine medical necessity.
Utilizes nationally recognized criteria t! o determine medical necessity of requested services.
Refers provider requests to Medical Director or designee when medical necessity of requested services does not meet recognized criteria.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to NaphCare, Inc..
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This job starts available on: Thu, 12 Dec 2013 17:27:33 GMT