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Utilization Management RN - Full-time / Part-time
| Hours | Part-time, Full-time |
|---|---|
| Location | Manor, Texas 78763 Manor, Texas |
About this job
Now Hiring a Utilization RN! APPLY NOW!
Qualifications:
-RN License (Texas)
-AT LEAST 3-5 years of RN experience
-1-2 years of Adult Medical/Surgical experience
-Experience in a Hospital or Health plan setting
-Experience within UR, appeals, prior auth
-MUST have great phone skills
-Payor based Utilization Review or Case Management Experience, CCM preferred.
-HIGHLY PREFERRED: Oncology experience, critical care, acute care, catastrophic case experience.
* Must have experience in Utilization Management which includes one or more of the following: Oncology /Chemotherapy and Radiation plan of care knowledge; Complex Medical-Surgical disease states;
* Transplants and NICU.
* Submit reviews to Medical Director and/or to Independent Review Organizations.
* Conducts prospective, concurrent, retrospective and appeals for utilization management including inpatient services, outpatient services, surgeries and behavioral health
* Document clinical information from faxed clinical along with verbal clinical obtained and creates related authorizations, denial and declination letters.
* Work with facility Case Managers/Discharge Planners regarding the most appropriate Level of Care for members
* Adheres to department guidelines and NCQA standards.
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.