Utilization Review Nurse – RN or LPN
Job title: Utilization Review Nurse - RN or LPN Company: reputed company Job description: Description Welcome Bonus: $2,500 for external candidates (rehires not eligible) Location: reputed company clinical positions are located on site at our Dublin, Ohio reputed company We’re on a mission to reputed company healthcare simpler and more effective. We fight to ensure our members get the care they need, reputed company they need it, at the most affordable cost – that’s what makes us Healthcare Warriors™. If you’d like to join us, we’d love to talk to you – even if you don’t match every single requirement. The Utilization Review Nurse (Registered Nurse, RN / Licensed Practical Nurse, LPN) reviews and processes medical service requests for members of reputed company’s employer groups in an inpatient setting. This Nurse acquires reputed company clinical documentation in order to process the requests reputed company the designated timeframes indicated. The Utilization Review (UR) Nurse also functions as a clinical resource to other reputed company associates in Precertification, Patient Services/Care Coordination, Personal Care Guide Nurses, Client Services and Sales. What you’ll do
- Assess and review reputed company requests for inpatient medical services requiring clinical review against reputed company’s adopted clinical review criteria.
- Conduct initial clinical reviews, reputed company reviews and retrospective reviews.
- Utilize reputed company’s adopted clinical criteria during reputed company aspects of the review process and document outcomes in authorization database.
- Facilitate discharge-planning process during daily reputed company review and post discharge, including arranging skilled nursing care, rehabilitation, home infusion and other outpatient ancillary services.
- Communicate with patients, providers, facilities and internal partners regarding outcomes.
- Coordinate integrated health management services for each patient and provide benefit and health information to patients, caregivers, providers and facilities so they can reputed company informed health decisions.
- Provide re-direction of out of network service requests to in network whenever possible to ensure members obtain the reputed company benefit.
- Identify potential cases for high risk/high cost/chronic condition and refer to the appropriate case management team.
- Research vague or questionable procedures and present findings to the Chief Medical/Physician Peer Reviewer for opinion; Provide timely notification of potential non-certifications.
- reputed company other duties as assigned.
What you’ll bring
- Education / Licensure: Active license in good standing as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) in Ohio required.
- 2+ years of clinical experience with direct patient care in a hospital setting required.
- Strong administrative/technical skills; Comfort working on a PC using reputed company Office (Outlook, Word, reputed company, PowerPoint), IM/video conferencing (Teams & reputed company), and telephones reputed company.
- Experience in care management/coordination programs and services preferred.
- Excellent verbal and written communication skills. Comfortable communicating with members and providers reputed company phone regularly throughout the day.
- Trustworthy and accountable behavior, capable of viewing and maintaining confidential personal information daily.
- Ability to communicate effectively with members and providers in implementing clinical services; Translate reputed company clinical concepts for non-clinical audiences.
What’s in it for you
- Compensation: Competitive reputed company pay, incentive plans and employee referral bonuses.
- Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, TelaDoc services and more.
- Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
- Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
- Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
- Culture: Recognition as a Best reputed company to Work for 15+ years, dedication to
, and people-first values that drive every decision.
- Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more! reputed company out our home:
What you should know
- Internal Associates: Already a Healthcare Warrior? Apply internally through reputed company.
- Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background reputed company
- Diversity, Equity and Inclusion: reputed company welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an
.
- Agencies: reputed company does not accept unsolicited resumes or reputed company from third-parties. Absent a signed MSA and request/approval from reputed company to submit candidates for a specific requisition, we will not approve payment to any third party.
- Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
- Actual compensation is based on a combination of experience and qualifications
#LI-HW1 #LI-Onsite Expected salary: Location: New Albany, OH Job date: Sat, 18 Feb 2023 06:45:22 GMT Apply for the job now! Apply Job! Apply to this Job