Responsibilities
You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.
Required Skills
Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
Associate Degree or Bachelors Degree – Nursing or Graduate of Accredited School of Nursing
MCG or InterQual tooling experience
Ability to obtain additional state licenses to meet business needs
1+ year of utilization review experience in a managed care setting
1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
Preferred Skills
BSN
Previous experience conducting concurrent or inpatient reviews for a managed care plan