Utilization Review Nurse – Utilization Management
Posted 5hrs ago
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Job Description
Utilization Management RN maximizing quality and cost-efficiency of health care services at ProMedica. Collaborating with the healthcare team for reviews, authorizations, and service utilization improvements.
Responsibilities:
- maximize the quality and cost-efficiency of health care services at ProMedica
- complete reviews for admissions and transfers
- apply payer rules to obtain authorizations
- work with physicians, nurses, and other members of the health care team
- review cases and look for opportunities to improve hospital service utilization
Requirements:
- Graduate of approved NLN accredited School of Nursing
- Minimum of 3 years acute care nursing experience
- Current RN licensed in the state of hire
- Knowledge of insurance guidelines
- experience with UR/UM in hospital acute care setting
- Previous experience with case management
- utilization review and InterQual criteria
Benefits:
- dental
- vision
- company paid life insurance
- paid time off
- a 401k retirement plan
- an employee assistance program
- other voluntary coverage options
- employee discounts
