Travel Nurse RN - Utilization Review
Hanover, MD
NuWest Travel Nursing
5x8 hrs, Days

UTILIZATION REVIEW NURSE

WORK Location- REMOTE

No Call. holiday or weekend

Required:

• ActiveRN MD License, (5) years RN experience, Current UR experience;
• EPIC and referral platforms such as NaviHealth or AllScripts.
• Knowledge and use of Proficiency using InterQual and/or Milliman criteria software systems,
• 1 year of Managed care experience in utilization review

Duties:

• Responsible for the day to day management of health confined plan members in acute care and/or rehabilitative facilities.
• The Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, acute hospital, sub-acute hospital, and acute rehabilitation facility.
• The Utilization Nurse applies member benefit and medical criteria to determine authorization of services in coordination with the Medical Directors.
• The Utilization Nurse proactively initiates discharge planning for of members, including identification of post-discharge needs and coordination of post discharge referrals/services.
• The UN communicates verbally and in writing authorization and/or denial of covered services with providers, facilities and members.
• The UN is a member of administrative and clinical teams in the area of assignment. Clinical knowledge is maintained and updated and UN must maintain acceptable documentation and quality standards.