Offer summary
Qualifications:
Graduate from an Accredited School of Nursing or BSN, 2 - 4 years of related experience, 2+ years of acute care experience required, Knowledge of Medicare and Medicaid regulations preferred, Knowledge of utilization management processes preferred.
Key responsabilities:
- Perform concurrent reviews for members' care
- Review quality and continuity of care
- Collaborate with healthcare providers on medical determinations
- Educate providers on utilization processes
- Provide feedback to leadership for care improvement