- Review medical charts and issue pre-authorizations for medical procedures based on patient needs, physician recommendations, and coverage
- Refer cases to the necessary health care providers based upon medical review findings that do not meet criteria
- Further the delivery of care across the Health Care System by coordinating between patients and health care providers
- Employ cost effective health care services based on medical necessity and contractual benefits
- 3+ years of hands on hospital clinical experience including critical care, step down unit or med surg.
- Must be a Licensed Partitional Nurse or Registered Nurse in the state of North Carolina or have multi-state compact licensure
- Hands on experience with evaluating medical records and charts
- Utilization review experience
- Managed care experience, preferred
- Compensation: $34 - $38/hr. based on years in industry and relevant experience
- Full Benefits: Medical, Dental, Vision, 401k
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Utilization Review Nurse - McLean, United States - Zachary Piper Solutions
Description
Piper Clinical Solutions is actively seeking a Utilization Review Nurse for a totally remote position. This team works to support one of the world's largest, most innovative healthcare providers bridge the gap between health care and medical coverage. The ideal candidate will have prior Utilization Review experience in a clinical or non-clinical setting. This is a remote, Monday through Friday, 8am-5pm position.
Responsibilities for the Utilization Review Nurse:
Qualifications for the Utilization Review Nurse:
Compensation for the Utilization Review Nurse: