Utilization Review RN

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Reference Code: 5868

Utilization Review Nurse

Location: REMOTE, Cincinnati, OH
Job Type: Contract
Duration: 3 months, possibility of extension
Pay Rate: $32.00/hour (can be adjusted depending on experience)

Our client, a Fortune 500 multi-state healthcare organization, is looking to hire a Utilization Review Nurse who will be responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time.
 

The Utilization Review Nurse will provide daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.

 

The Utilization Review Nurse will assess services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

 

Description:

  • The Utilization Review Nurse will work from home 100%
  • A day in the life of an Utilization Review Nurse include processing authorization requests using approved criteria, understanding CMS compliance UM emergent and standard organization determination and for member notification of the EOD/SOD, and facilitating care coordination for members who have Medicare and Medicaid coverage.
 
Job Qualifications:
  • The Utilization Review Nurse must have an active Registered Nurse License valid in the state of Ohio.
  • The Utilization Review Nurse must have experience in In-Patient Skilled Nursing Facility and using Milliman (MCG) criteria.
 

For more information on the Utilization Review Nurse role, please call our Recruiter directly at (847)610-9013. To submit your application, click on the 'Apply for Job' link below or send your resume directly to Joseph.Abeto@bluestonestaffing.com.

 

blueStone Staffing recruits top talent for some of the most desired companies on a contract, contract-to-hire and direct hire basis. We take pride in presenting our candidates with great opportunities they may not have exposure to elsewhere. By working with blueStone, you'll have access to rewarding job opportunities, competitive compensation, and industry leading benefits packages. We look forward to helping you land your next career opportunity and achieving your goals!

 

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