Travel Nurse RN - Utilization Review - 1,880 per week - Nashville - GQR Healthcare

    GQR Healthcare
    GQR Healthcare Nashville

    1 day ago

    Description
    GQR Healthcare is seeking a travel nurse RN Utilization Review for a travel nursing job in Baltimore, Maryland.
    Job Description & Requirements


    Specialty:
    Utilization Review

    Discipline:
    RN

    Duration:
    13 weeks
    40 hours per week

    Shift:
    8 hours, days

    Employment Type:
    Travel


    Shift:
    Mon – Fri, 8:00am-5:00pm EST


    WORK
    Location- REMOTE
    No Call. holiday or weekend

    There is no direct patient care, this is a medical review position only.

    Required:
    Active RN License, (5) years RN experience, Current UR experience; EPIC

    and

    referral platforms such as NaviHealth

    or AllScripts.

    Knowledge and use of Proficiency using InterQual and/or Milliman criteria software systems,

    Managed care experience in utilization review for at least 1 year preferred.


    Duties:
    Responsible for the day to day management of health confined plan members in acute care and/or rehabilitative facilities.

    The Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, acute hospital, sub-acute hospital, and acute rehabilitation facility.

    The Utilization Nurse applies member benefit and medical criteria to determine authorization of services in coordination with the Medical Directors.

    The Utilization Nurse proactively initiates discharge planning for of members, including identification of post-discharge needs and coordination of post discharge referrals/services.

    The UN communicates verbally and in writing authorization and/or denial of covered services with providers, facilities and members. The UN is a member of administrative and clinical teams in the area of assignment. Clinical knowledge is maintained and updated and UN must maintain acceptable documentation and quality standards.


    Skills:


    Excellent verbal and written communication skills to effectively interact and work correctively with enrollees, Physicians facility staff and management staff.

    Work requires excellent interpersonal skills and attitude to effectively project a positive image of our Managed Care Program. Computer skills working with a variety of applications and online systems. Knowledge of Enterprise and utilizing various criteria sets i.e. InterQual. Ability to negotiate and resolve conflicts with external customers.

    About GQR Healthcare

    GQR's Healthcare team specializes in connecting experts within the industry to highly skilled healthcare professionals across the US market.


    In the competitive healthcare market, we recognize that the industry's common goals of improved quality of care and patient outcomes are wholly reliant upon the professionals directly supporting these initiatives.

    Leveraging our extensive candidate network, we deliver continuity of care for the communities our partners serve to ensure the patient experience is of the highest quality.


    Through deep market specialization and a unique approach to talent acquisition, GQR Healthcare provides an unparalleled and personalized experience across all medical specialties in nursing and within diverse healthcare platforms across the industry.

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