Utilization Management RN
Utilization Management RN
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$ 74000 - 124000
1 Vacancy
Job Description
Job Family:
Clinical Appeals Nurse
Travel Required:
Clearance Required:
What You Will Do:
Performs chart review of identified patients to identify quality timeliness and appropriateness of patient care
Conducts admission reviews for Medicare Medicaid beneficiaries as well as private insurers and self-pay patients based on appropriate guidelines
Uses these criteria guidelines to screen for appropriateness for inpatient level of care or observation services based on physician certification
Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis
Performs concurrent and retrospective clinical reviews with various payers utilizing the appropriate guidelines as demonstrated by compliance with all applicable regulations policies and timelines
Adheres to CMS guidelines for utilization reviews as evidenced by utilization of the relevant guidelines and appropriate referrals to the physician advisor and the UR Committee
Identifies develops and implements strategies to reduce length of stay and resource consumption.
What You Will Need:
Associates degree minimum in nursing from an accredited school of nursing.
New York Nursing License - REQUIRED
4 years of experience in utilization management
Familiarity with MCG and InterQual guidelines
Ability to interpret a variety of instructions furnished in written oral diagram or schedule form
Ability to work 11am - 7pm EST weekends (occasional) and Holidays (occasional)
What Would Be Nice To Have:
Behavioral Health Experience
Skilled Nursing Facility experience
Inpatient Rehab Experience
Bachelors degree in nursing
What We Offer:
Guidehouse offers a comprehensive total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
Medical Rx Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program
About Guidehouse
Guidehouse is an Equal Opportunity EmployerProtected Veterans Individuals with Disabilities or any other basis protected by law ordinance or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities or to apply for a position and you require an accommodation please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Employment Type
Full-Time
