RN Case Manager | Utilization Management
Job Description
Networks Connect Professional Staffing is conducting a search on behalf of our client for an RN Case Manager/Utilization Management.
Responsibilities:
- Conduct timely clinical reviews drawing upon appropriate resources and apply nationally recognized criteria to support medical necessity of patient observation admission or inpatient admission and continued hospitalization.
- Address treatment delay, potential and actual denials with the Attending physician and other relevant members of the healthcare team.
- Provide clinical reviews to third party payers and validates authorization or denial of services from them.
- Document approved and denied services in STAR to facilitate meaningful data analysis.
- Communicate verbally and/or written e.g., email) with payers and healthcare team in a clear, timely, accurate and professional manner and/or organized in a professional format.
Qualifications:
- BSN (required), MSN (preferred)
- 5 years With at least three in clinical nursing. At least one year experience in Utilization Management with knowledge of utilization review criteria. Experience in one or more of the following areas: case management, designated/pediatric specialty
Job Type: Full-time
Pay: $100,000.00 – $125,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
- Hospital
Work Location: In person
Earnings
$100,000 - $125,000 salary
Location - In Office
- Silver Spring, MD
Job Type
Full-time
Category
Revenue Cycle