Clinical Review Nurse

4 weeks ago


Omaha, Nebraska, United States Applied Underwriters Full time
Job Summary

As a Clinical Review Nurse - Utilization Management, you will play a crucial role in ensuring the medical necessity of care provided to claimants. This involves reviewing clinical information, utilizing evidence-based guidelines, and coordinating care across the continuum. You will interact with physicians, providers, claimants, and peer reviewers to ensure that care is aligned with established criteria.

Key Responsibilities
  • Review clinical information to determine medical necessity of care
  • Utilize evidence-based guidelines to inform decision-making
  • Coordinate care across the continuum, ensuring seamless transitions
  • Interact with physicians, providers, claimants, and peer reviewers to ensure alignment with established criteria

Requirements
  • Current and unrestricted RN license in the state of Nebraska or a compact state
  • At least 5 years of clinical experience
  • Familiarity with utilization review process, case management, and/or discharge planning
  • Proficiency in Microsoft Windows, including Word, Excel, Outlook, and ability to create PDFs

Company Benefits
  • Fully-paid employee Medical Insurance, Dental Insurance, and Vision Insurance
  • Fully-vested employer match 401(k)
  • Section 125 - Flexible Spending Account
  • In-house pharmacy providing employees significant savings and convenience
  • Tuition Reimbursement

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