Utilization Review Nurse

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Interested in being considered? IF IS JOB OPPORTUNITY IS FOR YOU, GIVE ME A CALL AT View phone number on click.appcast.io Job Description Day to Day Responsibilities: Conducts utilization management activities in accordance with Utilization Management policies and procedures. Responds to calls, conducts certification reviews, facilitates the discharge planning and referral process and coordinates denials with physician advisors for all assigned programs. Receives prospective & concurrent requests for service. Coordinates certification reviews for pre-admission, continued stay and retroactive reviews. Interprets and applies clinical information to make delivery decisions and determine appropriate level of care for utilization review activities. (50%) Follows departmental policies & procedures for review, determination & notification. Ensures day to day UM processes are conducted in accordance with NCQA, URAC and other regulatory standards. (15%) Maintains effective interactions/communication w/ outside providers to assure appropriate delivery of service to members. (10%) Reviews requests for medical necessity (referring cases to medical director that require additional expertise). Coordinate denials with physician advisors (10%) Documents all activities per APS policies and procedures. (15%) Work is performed in a professional office setting, business casual dress environment. Working extended hours may be required as needed. IF IS JOB OPPORTUNITY IS FOR YOU, GIVE ME A CALL AT View phone number on click.appcast.io ASAP! Qualifications RN License in NY with 2 years of experience Computer literate. This includes simultaneous use of multiple programs and applications; navigating varied file formats; performing copy/paste, save, and update information in multiple formats. Utilization Review Experience, the nurse can come from a Hospital, Home Health, or Managed Care company/ health plan Additional Information Hello! My name is Krishna Gapuz and I am a Recruting Consultant with Healthcare Support . I specialize in the placement of medical professionals nationwide (both clinical and non-clinical). We just had an amazing opportunity become available for a Utilization Review RN right in Syracuse, NY (Zip Code 13202 ). They are looking to start a qualified candidate as quickly as possible (pending hire requirements). This is an amazing opportunity for a Monday – Friday 8:00a.m.-6:00p.m . job with a stable, prestigious company (This Company is one of the leading providers of Healthcare in your area!) If you would like to be considered for this opportunity please respond to this Email as soon (today) as possible! (or you’re more than welcome to call me at my office View phone number on click.appcast.io. If you opt to respond to this Email, please include: Why did you leave your last position and how long ago (or why are you looking to leave your current position)? How much were you last making (hourly)? #J-18808-Ljbffr