Posted : March 1, 2021
Job Type : Contract
Category : Healthcare
- 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
- 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
- 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
Judge Healthcare is currently seeking a REMOTE Utilization Review RN for one of our top healthcare clients!
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