Utilization Management Nurse

Job TitleMUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina (MUSC) that provides healthcare to patients within the rural health network throughout the state of South Carolina. Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition.Entity: MUSC Community Physicians (MCP)Worker Type: EmployeeWorker Sub-Type: RegularCost Center: CC005921 MCP - Utilization ManagementPay Rate Type: HourlyPay Grade: Health-28Scheduled Weekly Hours: 32Work Shift: Job DescriptionConducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed.Bachelor's degree in Nursing from an accredited school of nursing and three years' work experience as a Registered Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement. Must possess excellent verbal and written communication skills. Familiarity with InterQual or Milliman and Robinson screening criteria desired. Licensure as a registered nurse by the state of South Carolina or compact state required.Additional Job Description:Benefits:Health, dental, vision, and life insuranceEmployer Sponsored Retirement PlanPaid time off and extended sick leavePaid Parental LeaveDisability insurance plan optionsContinuous professional and clinical trainingCompetitive payAnnual Merit IncreaseWellbeing resourcesTuition ReimbursementEmployee perks and discountsEmployee referral programFlexible schedule optionsCertification incentive programIf you like working with energetic enthusiastic individuals, you will enjoy your career with us!The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.