Utilization Management Nurse Position Available In Pulaski, Arkansas

Job Description:

Title:

Utilization Management Nurse Duration:

1 year

ContractLocation:

Little Rock, AR (100% Remote)

Rate:

$33-$35/hr on W2

Keytechnologies:

Internet Download speed—100 Mbps (confirming withIT), Camera on with Team, Holiday availability (Flexible hours),Reporting any issues to the leader ASAP, and maintainingcommunication.

Nice to have:

Clinical review of prior approvals,network exceptions, benefit inquiries, inpatient medical/surgicaladmissions, outpatient procedures for providers, and/or othercontracted lines of business. Organized, able to adjust tochange/fast-paced environment Time zone: CST Number of Openings – 4One position 8 am-5 pm (CST) Tuesday – Saturday One position 8 am-5pm (CST) Sunday-Thursday One position 8 am-5 pm (CST) Monday-FridayOne position 11 am-7 pm (CST) Monday-Friday Job Summary UtilizationManagement Nurse performs clinical review of prior approvals,network exceptions, benefit inquiries, inpatient medical/surgicaladmissions and outpatient procedures for providers, and/or othercontracted lines of business. This role assesses and evaluates theefficiency and appropriateness of services for medical necessitythrough interpretation and review with evidenced-based criteria,clinical guidelines, corporate guidelines and policies and mandatesand standards. Incumbent also facilitates and promotes appropriatecare and quality toward cost effective and cost containmentmeasures based on evidence.

Education & Experience:

1. RegisteredNurse License, active and unencumbered state license in the statewhere job duties are performed is required. BSN preferred. 2. Four(4) years of clinical practice nursing experience in at least oneof the following areas: medical-surgical nursing, surgical nursing,intensive care or critical care nursing. 3. Proficiency using basiccomputer skills in Microsoft Office such as Word, Excel, andOutlook, including the ability to navigate multiple systems andkeyboarding 4. Experience in utilization management and/or medicalreview preferred. Specialized Knowledge & Skills Ability toprioritize and make sound nursing judgments through criticalthinking Excellent verbal and written communication skills Abilityto build collaborative relationships Attention to details Abilityto interpret complex documentation Ability to work independently

Professional Certification or Licenses:

Registered Nurse LicenseResponsibilities Utilization Management:

Conducts and monitorsclinical review cases to ensure medical necessity of inpatient andoutpatient services, diagnostic procedures, out-of-networkservices, and surgery; documenting all relevant and specificinformation; and screens, prioritizes and organizes determinationrequests according to mandates and standards. Promotes appropriatecare and quality toward cost effective and cost containmentmeasures based on evidence.

Communication:

Collaborates withhealthcare providers and internal staff to promote quality of care,cost effectiveness, accessibility and appropriateness of servicelevels.

Compliance:

Practices nursing within the scope of licensureand adheres to policies, procedures, regulations, URAC standardsand individual state regulations; making decisions based on factsand evidence to ensure compliance, appropriate level of care, andpatient safety.

Workflow:

Proactively and efficiently work incomingand outbound calls and/or queues from multiple sources withinmandated requirements.

Knowledge:

Remain current with up-to-datemedical and surgical procedures, products, healthcare services anddrugs, general trends in health care delivery; and enterpriseprocedures, policies and contracts. Other duties as assigned. WorkExperience Utilization Review 2 years Care Management 2 years