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Utilization Review Nurse

Company: Aerotek
Location: Jacksonville
Posted on: April 9, 2021

Job Description:

Actively seeking LPNs with strong utilization review experience to join a growing managed care organization on a 100% remote basis! This is your choice of 4 - 10 hour shift or 5 - 8 hour shift with 1 weekend day included! Must have experience with interqual! Video interviews are being set up quickly! Apply today!Description:

  • Performs an initial evaluation of the referrals appropriateness for services.
  • Reviews for information needed to make a medical necessity determination. Requests additional clinical information when needed to render a decision and determines next steps.
  • Using clinical expertise, reviews clinical information and clinical criteria to determine if the service/device meets medical necessity for the patient.
  • Ensure case review and elevation to complete the determination is rendered within the contractual and regulatory turnaround time standards to meet both contractual and regulatory requirements.
  • Interact with the Medical Director as needed to ensure proper medical necessity decisions are being made in a timely manner.
  • Acts as a clinical resource to department care coordinators, providing expertise and clinical support.
  • Develops/maintains a working knowledge of all services/guidelines/policies and accesses contract information, including the terms of the contract as appropriate.
  • Manages multiple tasks, is detail oriented, responsive, and demonstrate independent thought and critical thinking.
  • Reviews and adheres to all Company policies and procedures and the Employee Code of Conduct.Qualifications:
    • Associate's Degree or Diploma in Nursing/Practical Nursing required
    • Must be a Registered Nurse/LPN/LVN or RT with Licensure in the state(s) of practice (based on allowable state practice act) is required during time of employment.
    • Minimum of 2 years of experience in a clinical setting required.
    • Broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior utilization management/review experience, and governmental home health agency regulations preferred.
    • Excellent negotiation, communication, problem solving and decision making skills also preferred. About Aerotek:We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Keywords: Aerotek, Jacksonville , Utilization Review Nurse, Other , Jacksonville, Florida

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