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Job Summary:
The
Utilization Management Nurse will be
responsible for utilization management,
utilization review, or concurrent review
(On-Site inpatient care management).
He/She will perform reviews of current
inpatient services; determine medical
appropriateness of inpatient and
outpatient services following evaluation
of medical guidelines and benefit
determination.
Job
Description:
The
Utilization Management Nurse will perform
all or some of the following Job
description:
-
Perform utilization management,
utilization review, or concurrent
review ( telephonic inpatient care
management)
-
Determine medical appropriateness of
inpatient and outpatient services
following evaluation of medical
guidelines and benefit determination
-
Assess and interpret customer needs
and requirements
-
Identify solutions to non-standard
requests and problems
-
Work
with minimal guidance; seeks
guidance on only the most complex
tasks
-
Translate concepts into practice
-
Provide explanations and information
to others on difficult issues
-
Coach, provide feedback, and guide
others
-
Act
as a resource for others with less
experience.
Minimum Requirements / Knowledge /
Skill For Utilization Management
Nurse Job
-
3 or
more years of Managed Care and/or
Clinical experience
-
1+
year of experience in Case
Management or Utilization Review
-
Basic
level of experience with Microsoft
Word, with the ability to navigate a
Windows environment
-
Pre-authorization experience.
Minimum Education Requirements /
Certification / Licensure For
Utilization Management Nurse
Job
-
Unrestricted RN license required in
the State the position is located
-
Certified Case Manager (CCM)
-
Undergraduate degree.
Find More management Job Descriptions Here
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