Utilization Review Nurse

2 weeks ago


Spencer, United States HexaQuEST Health, Inc. Full time
Job Description:

As a Utilization Review Nurse with HexaQuEST Health, Inc., you will play a critical role in ensuring the quality and efficiency of patient care. Your primary responsibility will be to review medical records for clear admission orders, documentation of medical necessity for admission and continued stay criteria, using the appropriate Milliman care guideline criteria.

Key Responsibilities:

Assist with the admission and continued stay reviews on all patients admitted to the med-surg/ swingbed, behavioral health, ICU / PCU and OB units.
Review medical records for clear admission orders, documentation of medical necessity for admission and continued stay criteria, using the appropriate Milliman care guideline criteria.
Perform utilization review activities for Medicare, Medicaid, Private insurance and self-pay patients.
Communicate with Patient Accounts on patient's level of care, insurance coverage, authorization numbers, and benefit information.

Requirements:

5 years of experience in direct patient care along with a minimum of 3 years in a Utilization Review role.
Must be currently active in the state.
36 minimum guaranteed hours.

Working Conditions:

Standard business hours, Monday to Friday, 8a-4:30pm.
Will discuss schedule expectations based on candidate and facility needs.

Benefits:

Competitive salary and benefits package.
Opportunity to work with a dynamic and growing healthcare organization.

How to Apply:

Please submit your application, including your resume and cover letter, to [insert contact information].

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