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Utilization Review Nurse
2 months ago
About Avera Health Plans:
Avera Health Plans is a leading healthcare organization dedicated to providing high-quality medical services to its members.
Job Summary:
The Utilization Review Nurse will be responsible for ensuring that members receive the right care at the right time and place. This will involve authorization processes, care coordination, and review of outpatient/inpatient care.
Key Responsibilities:
- Authorization of medical services to ensure they are medically necessary and meet the requirements of the member's plan.
- Care coordination with healthcare providers to ensure that members receive comprehensive and coordinated care.
- Review of outpatient and inpatient care to identify areas for improvement and ensure that members receive the best possible care.
Requirements:
- Bachelor's degree in Nursing preferred.
- Minimum of five years of professional nursing practice experience.
- Managed Care experience in an HMO setting preferred.
- Proficient in Microsoft Word, Excel, Access, and PowerPoint.
- Registered Nurse in the state of South Dakota and/or meeting the requirement of Multistate licensure.
Work Schedule:
Monday-Friday, 8:00am-5:00pm; 80hrs/2wks.
Compensation:
$44.25 per hour.
