Madea Home Care Services
Location
Richardson County, Nebraska
Salary
$38 - $40 / HOUR
The Utilization Review Nurse is responsible for performing initial and concurrent review activities, as well as discharge care coordination. They serve as a liaison between providers and medical management divisions to ensure the quality and effectiveness of medical services.
Candidates must be a Registered Nurse with a valid license and have at least 3 years of clinical experience in relevant healthcare settings. Knowledge of medical terminology and strong communication skills are also required.
Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties***
RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities. JOB QUALIFICATIONS (Required): Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company. Knowledge of medical terminology and procedures. Verbal and written communication skills.
JOB QUALIFICATIONS (Preferred): MCG or InterQual experience Utilization management experience
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