Utilization Review Nurse
3 weeks ago
We are hiring a Fully Remote UM Nurse for a Health plan based out of New York MLTC LTSS(home care, personal care, DME service reviews) Plan experience is required.
Requirements: NY RN license (UM experience is required, MLTC LTSS experience required)
Hours: Monday - Friday 9am-5pm or 8am-4pm (Full time hours only)
Location: Remote (based out of NY)
Pay: $45-50/hr
Job Details:
Conducts comprehensive review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, paraprofessional staff, caregivers and other relevant sources as necessary.
- Assesses member needs and identifies solutions that promote high quality and cost-effective health care services.
- Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations.
- Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective. Works under general supervision.
#Medix #MedixNE
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