RN Case Manager - UR Nurse

• 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

• 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

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