Regional UM Registered Nurse

1 week ago


Albuquerque, New Mexico, United States Recruitics JB Full time
Job Summary

We are seeking a highly skilled Utilization Management Nurse to join our team at Wexford Health Sources, Inc. As a key member of our healthcare team, you will play a critical role in ensuring cost-effective outcomes while maintaining a focus on quality care for inpatient and/or outpatient services.

Key Responsibilities
  • Monitor on-going medical needs and services by evaluating medical necessity, appropriateness, and efficient use of healthcare services for inpatient hospitalizations and/or outpatient procedures.
  • Work closely with physicians, hospital utilization management, and correctional facilities to provide quality, cost-effective care at the level most appropriate to the inmate-patient.
  • Provide reports and recommendations to medical and facility staff for improved utilization of resources.
Requirements
  • Current licensure as a Registered Nurse (RN) in the state of New Mexico.
  • Minimum of 2 years of experience in utilization management or a related field.
  • Strong knowledge of InterQual Criteria and/or Milliman Admission Criteria.
  • Excellent communication and interpersonal skills.
Benefits
  • Annual review with performance increase.
  • Generous paid-time off program that combines vacation and sick leave.
  • Paid holidays.
  • Comprehensive health insurance through Blue Cross Blue Shield.
  • Dental and Vision insurance.
  • 401(k) retirement saving plans.
  • Company-paid short-term disability.
  • Healthcare and dependent care spending account.


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