Utilization Review Nurse
3 weeks ago
Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating and authorizing essential healthcare services.
Shift: Monday - Friday (8am - 5pm Normal business hours)
Type: Temp to Hire (Candidates will be remote but need to reside in the tri-state area (PA,NJ)
Pay Rate: 37.50 -40.00 Hourly (paid weekly)
What You'll Do:
- Clinical Analysis: Review medical records to determine the necessity of patient services based on advanced criteria.
- Provider Interaction: Collaborate with healthcare providers to clarify and obtain additional clinical information.
- Decision-Making: Authorize medically necessary services and refer cases that don't meet criteria to the Medical Director.
- Compliance & Advocacy: Ensure adherence to regulatory standards and act as a resource for members navigating the healthcare system.
- Data Management: Maintain accurate records and report trends or issues to improve care quality.
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Utilization Review Nurse
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Atlanta, United States Sonder Health Plans Full timeJob DescriptionJob DescriptionJob Description:The Utilization Review Nurse’s role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective...
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Utilization Review Nurse
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