Utilization Management Nurse

UTILIZATION MANAGEMENT NURSE

Job Description:

-Performs concurrent review on medical patients, determines medical necessity by application of criteria per Utilization Management Dept Policy and specific Health Plan guidelines.
Recommend an increase or decrease in level of care/equipment/service based upon medical condition and physician orders.
-Refer all services that do not meet established criteria, to the -Medical Director. Notify all parties of Medical Director determinations, and communicate alternate service options when indicated.
-Responsible for the assessment of the member's and family's psychosocial, medical and educational level in conjunction with hospital staff to assist in the discharge planning of hospitalized patient. This includes providing authorization for needed services through vendors in accordance with payer networks.
-Monitor ongoing planning process with medical team to ensure positive outcomes and timely transition to the next level of care.
-This concurrent evaluation will determine plan effectiveness of reaching the desired goals and outcomes.
-Document all pertinent information obtained through discussion with providers, patients, family members and other health care professionals in the Milliman (MCG) software.
-Through the discharge planning process, helps identify members who have ongoing case management needs, and refers these members to the Case Management team for outreach and follow up.

Qualification:

-Registered Nurse in IL

-Experience in Utilization Revie in an insurance or hospital setting

-Familiar with multiple EMR systems

-Ability to work M-F

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.

Aerotek is acting as an Employment Agency in relation to this vacancy.