UTILIZATION MANAGEMENT NURSE 7/31/2018

HealthSmart Charleston, WV

Location
Charleston, WV
AJE Ref #
582399867
Job Classification
Full Time
Job Type
Regular
Company Ref #
2004
Experience
Entry Level (0 - 2 years)

JOB DESCRIPTION

APPLY
Registered nurse that serves as a liaison between providers and external payers on issues related to intensity of service and severity of illness for client members. This position involves using clinical background in the coordination of services to improve and maintain quality patient care and appropriate utilization of resources in the delivery of that care. Our goal is to improve the health of our members and reduce healthcare costs by using cutting-edge technology through our dedicated, creative team of professionals.
JOB RESPONSIBILITIES & ESSENTIAL FUNCTIONS:
Provide pre-procedure, pre-admission, admission, concurrent and retrospective reviews.
Apply medical management criteria.
Research clinical questions from employers, members and payers.
Assist claims with quality reviews.
Perform member referral to case management services as indicated.
Educate members on health access options.
Maintain a high level of accuracy and clinical competency in order to meet URAC Accreditation guidelines..

HealthSmart is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, national origin, disability or protected veteran status. If you'd like more information about your EEO rights as an applicant under the law, please visit : http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf
EOE Minorities/Females/Disability/Veterans; VEVRAA Federal Contractor
If you need reasonable accommodation to complete the on-line application, please contact the Human Resources Department at HR@healthsmart.com