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Reference: #703799

Utilization Review Nurse (RN)

REMOTE

Posted : March 1, 2021

Job Type : Contract

Category : Healthcare

Description

    Judge Healthcare is currently seeking a REMOTE Utilization Review RN for one of our top healthcare clients!

    Position details:

    • Location: REMOTE, but must reside in the state of Texas
    • Start Date: ASAP

    • Duration: 4 months with the possibility to extend
    • Hours: 9am – 6pm CST/ Monday – Friday and rotating Saturday shift

     

    Job Requirements:

    •  Performs utilization review activities, including pre-certification, concurrent, and retrospective reviews according to guidelines
    • Determines medical necessity of each request by applying appropriate medical criteria to first level reviews and utilizing approved evidenced based guidelines / criteria
    • Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services
    • Answers Utilization Management directed telephone calls; managing them in a professional and competent manner
    • Refers case to a review physician when the treatment request does not meet necessity per guidelines, or when guidelines are not available. Referrals must be made in a timely manner, allowing the review physician time to make appropriate contact with the requesting provider in accordance with departmental policy and within CMS or URAC mandated turnaround times
    • Identify and refer potential cases to Disease Management and Case Management

    .Job Requirements:

    • Current, unrestricted Texas RN license or compact license
    • Reside in the state of Texas 
    • 2+ years of experience in managed care OR 5+ years nursing experience
    • Ability to interact productively with individuals and with multidisciplinary teams with minimal guidance

    All interested and qualified candidates can apply directly to Sheden Medhanie at smedhanie@judge.com, or call Sheden at (972) 966-0936 for immediate consideration.

Apply now

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