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Clinical Review Nurse

2 months ago

Buffalo, New York, United States Independent Health Association Full time
Job Summary

We are seeking a skilled Utilization Review Nurse to join our team at Independent Health Association. As a Utilization Review Nurse, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.

Key Responsibilities
  • Perform clinical reviews to determine the medical necessity of requested services
  • Obtain and review clinical information to determine medical necessity
  • Consult with the Associate Medical Director as needed to determine medical necessity
  • Provide high-quality, professional utilization management services
  • Maintain accurate records of clinical information and medical necessity reviews
  • Complete requests in compliance with designated turn-around times
Requirements
  • Active, current, unrestricted, and licensed registered nurse required
  • Associates degree in health-related field; BSN preferred
  • Three (3) years of clinical experience in acute hospital care and/or three (3) years of utilization review experience required
  • Previous experience in managed care preferred
  • Clinical knowledge of the health or social work needs for the population served
  • Demonstrated ability to identify barriers to a successful care management path
  • Demonstrated ability to interact effectively with physicians and other members of the healthcare system
  • Proficient PC and Windows skills required, including MS Office
  • Excellent problem-solving abilities and time management skills
  • Excellent written, verbal, and interpersonal communication skills
What We Offer
  • Competitive hourly rate of $38.00
  • Scorecard incentive program
  • Full range of benefits
  • Generous paid time off

Independent Health Association is an Equal Opportunity / Affirmative Action Employer and welcomes applications from diverse candidates. We are committed to creating an inclusive work environment that values diversity, equity, and inclusion.