[Hiring] Utilization Management Nurse @West Coast Consulting
Role Description Utilization Management Nurse
- REMOTE
- RN license number must be valid for Arkansas
- Can work on holidays and during the weekend
- Utilization Management:
- Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery.
- Documents all relevant and specific information.
- Screens, prioritizes, and organizes determination requests according to mandates and standards.
- Promotes appropriate care and quality toward cost-effective and cost containment measures based on evidence.
- Knowledge:
- Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery, and enterprise procedures, policies, and contracts.
- Other duties as assigned.
- Schedule Notes:
Qualifications
- Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook.
- Ability to navigate multiple systems and keyboarding.
- Experience in utilization management and/or medical review preferred.
Requirements
- Ability to prioritize and make sound nursing judgments through critical thinking.
- Excellent verbal and written communication skills.
- Ability to build collaborative relationships.
- Attention to details.
- Ability to interpret complex documentation.
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