Concurrent Review Nurse for Utilization Management
1 week ago
Brighton Health Plan Solutions, LLC is seeking a dedicated Utilization Management Nurse to provide essential services in the realm of healthcare management. This role is pivotal in conducting daily assessments of medical necessity and will report directly to the Director of Clinical Programs.
Key Responsibilities
- Perform utilization assessments and make approval decisions for members based on established evidence-based guidelines and internal protocols.
- Identify potential cases involving Third-Party Liability and Coordination of Benefits.
- Ensure that discharge planning aligns with the needs of members and ascertain requirements for post-acute care.
- Refer members to appropriate departments as necessary.
- Review documentation and communications to ensure compliance with regulatory standards.
- Present cases for medical review and communicate findings effectively.
- Provide constructive feedback aimed at enhancing the quality of care.
- Evaluate transfer and discharge plans to facilitate timely transitions.
- Current licensure as a Registered Nurse.
- Strong proficiency in Microsoft Office applications.
- Ability to operate independently in a dynamic work environment.
- Comprehensive understanding of the Utilization Review process and relevant medical policies.
- Experience in clinical nursing within a managed care context.
- Familiarity with Third-Party Administration is preferred.
About Us
The Utilization Management Nurse is an integral part of Brighton Health Plan Solutions, LLC, contributing to our mission of transforming healthcare access and delivery. We are committed to fostering an inclusive culture that values diversity and collaboration to enhance member experiences and achieve healthcare objectives.
Company Mission
To enhance the accessibility and delivery of healthcare through exceptional products and services.
Company Vision
To redefine the quality and value of healthcare by aligning the incentives of our partners.
Diversity, Equity, and Inclusion Commitment
At BHPS, we cultivate a culture that embraces diversity, inclusion, and belonging. We encourage individuals to bring their unique perspectives and experiences to create a welcoming workplace.
Compensation
Annual Salary Range: $75,000 - $90,000. Salaries are determined based on various factors, including location, experience, education, and skills.
Important Notice
Please be aware of recruitment scams that may falsely claim to represent Brighton Health Plan Solutions. Our legitimate hiring process does not involve text-based interviews or requests for payment. All available career opportunities are listed on our official Careers section. Report any suspicious activity to the appropriate authorities.
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