[Hiring] Utilization Management Nurse @West Coast Consulting

Role Description

Utilization Management Nurse
• REMOTE
• RN license number must be valid for Arkansas
• Can work on holidays and during the weekend
• Utilization Management:
• Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery.
• Documents all relevant and specific information.
• Screens, prioritizes, and organizes determination requests according to mandates and standards.
• Promotes appropriate care and quality toward cost-effective and cost containment measures based on evidence.
• Knowledge:
• Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery, and enterprise procedures, policies, and contracts.
• Other duties as assigned.
• Schedule Notes:

Qualifications
• Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook.
• Ability to navigate multiple systems and keyboarding.
• Experience in utilization management and/or medical review preferred.

Requirements
• Ability to prioritize and make sound nursing judgments through critical thinking.
• Excellent verbal and written communication skills.
• Ability to build collaborative relationships.
• Attention to details.
• Ability to interpret complex documentation.

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