Remote Utilization Management Nurse – Part Time
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Salary: $35 To $65
Job Location: USA
Job Type: Part/Full Time
Medix</strong>u00a0is looking for a self-motivated and passionateu00a0RNu00a0</strong>for ouru00a0Full-Time Remote Utilization Management Nurse</strong>u00a0with a Health Plan on their Commercial team. This position requires previous Utilization Review or Utilization Management experience due to it being 100 percent remote. The company will not be able to train candidates with no prior UM/UR experience. Must haveu00a0MCG</strong>u00a0experience. See below for more details!rnrnHours</strong>: Sunday – Thursday or Tuesday – Saturday(8am – 5pm)rnrnTraining:</strong>u00a0Monday – Friday (8am-5pm)rnrn<u>Summary/objective</u></strong>rnrnAs a Utilization/Clinical Review Nurse, you will determine the medical appropriateness of inpatient and outpatient services by reviewing clinical information and applying evidence-based guidelines. You will also interact with the health plan providers, members, and internal service team to obtain necessary information and communicate approval determinations. This role has potential to flip to a direct hire after the contract is completed.rnrnPrimary Duties and Responsibilities :</strong>rn<ul>rn t<li>Collect relevant medical information (via telephone and fax) and apply the appropriate evidence-based guidelines and medical policies to determine medical necessity which could include Health Plan\'s Clinical Guidelines, Milliman Care Guidelines, Hayes, UpToDate, etc.</li>rn t<li>Meet required decision-making timeframes, including promptly triggering escalation for cases requiring physician review</li>rn t<li>Follow documentation guidelines for clear and concise decision-making within our utilization review tracking platform</li>rn</ul>”,”hiringOrganization”:{“@type”:”Organization”,”name”:”Medixu2122″,”logo”:”https://njoynews.com/wp-content/uploads/2022/09/800px_COLOURBOX31194598.jpg”},”identifier”:{“@type”:”PropertyValue”,”name”:”Medixu2122″,
Remote Utilization Management Nurse – Part Time – Gov Jobs