RN Case Manager - UR Nurse

Job Description

• Perform review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations

• Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings

• Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care

• Conduct discharge planning

• Educate providers on utilization and medical management processes

• Provide clinical knowledge and act as a clinical resource to non-clinical team staff

• Enter and maintain pertinent clinical information in various medical management systems

Qualifications

• Looking for nurses with 2 years RN exp in acute care with some utilization mgt, prior authorization, concurrent review, great with Excel and someone who can Multitask (e.g. on the phone while using multiple monitors)

• Will look at nurses from Home Health, doctor office or Hospice who have processed authorizations 

• Previous exp using TruCare system

• Strong Excel exp

• Background in diverse populations/environments (e.g. Critical care, ICU, cardiac, neonatal, pediatric, Case Mgt, etc)

• Processing 10-15 authorizations a day

Additional Information

 Interested in hearing more about this great opportunity? Please click Apply or call Ashley Greene  at 407-478-0332 Ext. 169

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!