Utilization Review Nurse

Work set-up: 
Full Remote
Contract: 
Work from: 

Offer summary

Qualifications:

Valid Michigan RN license is required., Utilization management experience is essential., Experience with post-acute reviews in rehab and skilled nursing settings preferred., Knowledge of post-acute InterQual criteria and good computer skills are needed..

Key responsibilities:

  • Conduct utilization reviews for patients in inpatient rehab and skilled nursing facilities.
  • Coordinate care activities and discharge planning to ensure safe member transitions.
  • Apply post-acute InterQual criteria in review processes.
  • Maintain documentation and communication within healthcare teams.

LanceSoft, Inc. logo
LanceSoft, Inc. XLarge https://www.lancesoft.com
5001 - 10000 Employees
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Job description

Job Description: 
  • This position will be remote role for Nurses in Michigan
  • Should have a valid MI RN License 
  • Should Have utilization management experience
  • Should have experience completing post-acute reviews for the inpatient rehab, skilled nursing facility settings previously
  • The candidate should be well versed in coordination of care activities along with discharge planning which is a plus for this role in ensuring members are transitioned safely following care.
  • In addition, the candidate should have knowledge of post-acute InterQual criteria that is utilized in this role.
Requirements:
  • Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.
  • One year health insurance plan experience or managed care environment preferred. Registered Nurse with current unrestricted Michigan Registered Nurse license required.
  • Certification in Case Management may be preferred based upon designated department assignment.
  • Above average computer skills 
  • linical experience in ICU, ER, or medical surgical unit preferred. .

Required profile

Experience

Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Computer Literacy

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