Utilization Review Nurse (Full-Time -- Eau Claire, WI; Salt Lake City, UT; Jackson, MS; Oklahoma City, OK)


 The Utilization Review Nurse is a vital component in our pre-certification process and works closely with a small team of other medical professionals.  The job duties include, but not limited to, the following:    

 Provide high quality, professional utilization management services by phone

*     Prompt, courteous, and error free in response to utilization management functions
*     Maintains volume of calls which is comparable to average number of calls handled by unit
*     Maintains quality of work by using sound judgment, good analytical and communications skills with attention to detail
Maintain accurate records
*     Clear documentation of medical necessity for all admissions and/or extensions
*     Accurate completion of CPT and hard copies
*     Complete follow through for disposition of cases – MD reviews, chart reviews, audits, case management referrals
*     Maintains current information on hospital – TPA accounts (resources)
Provide technical and professional expertise
*     Demonstrates accurate understanding of contractual issues for all accounts
*     Ability to ascertain if appropriate information for completion of inquiry (i.e. medical necessity)
*     Maintains current level of knowledge for nursing, medical and health trend issues
*     Exhibits problem solving approaches
*     Ability to resolve issues prior to becoming a problem
*     Acts as a resource for professional information
Active participation in our mission statement
*     Provide empathy and support to all clients who enter our sphere of influence
*     Demonstrates ability to interface with both professionals and nonprofessionals to ensure completion of inquiry in a satisfactory manner
*     Ensure maintenance of confidentiality of sensitive information.
*     Work with peers and management toward procedure standardization so as to develop consistency and efficiency in providing service to our customers
Other duties as assigned by management
 
Job Requirements:
*        Active, unrestricted RN licensure in State of Residence
*     Three years acute hospital care and/or UR experience preferred
*     Excellent verbal/written communication skills
*     Must be self-motivated
*     Typing/computer skills a must
*     Ability to work standard business hours Monday-Friday (8:30am-5:00pm)
*     Ability to travel to Columbus, OH for 2 weeks of training
 
If you are interested in this position, please submit your resume to humanresources@ahhinc.com