Registered Nurse

Integrated Resources Inc.; Harrisburg (Dauphin County); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading staffing firm seeks candidates for a clinical assessment role. This position involves evaluating clinical information for medical necessity, requiring a clinical background, especially in managed care environments. Key skills include effective communication and professional judgment. Join a reputable firm committed to quality service and integrity.

Qualifications

• Required: RN with two years in an acute care hospital.
• Preferred: Two years in managed care quality assurance or utilization review.

Responsibilities

• Evaluate clinical information submitted by providers against plan review criteria.
• Communicate with providers to coordinate outpatient services.
• Create and maintain monthly reports on inpatient activities.

Skills

Clinical information evaluation

Communication

Professional judgment

Education

Associates RN degree

Bachelor’s degree

Job description

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Principal Accountabilities:
• Evaluates clinical information submitted by providers against plan review criteria and benefit guidelines.
• Utilizes clinical information to determine if criteria for medical necessity and benefit guidelines are met.
• Utilizes professional judgment to determine if additional information is required, then follows through to obtain additional information prior to making a decision.
• Documents all pertinent case information and dispositions for approvals and denials. Refers all cases failing to meet interqual medical necessity criteria to Medical Director for review and final determination.
• Communicates with providers to initiate/coordinate outpatient services/discharge planning needs for members.
• Acts as a liaison to assure services are provided in the least restrictive, most cost effective and clinically appropriate setting.
• Works with the Utilization Management Manager, the Medical Director and providers to ensure that complete medical information is available to allow utilization management decisions to be made within The Plan’s standards for decision making.
• Identifies potential members who may benefit from case management services and facilitates referral to the program.
• Identifies and resolves any problems that could interfere with provider’s continuity and coordination of care of members and refers unresolved problems to Manager.
• Creates and maintains monthly reports on inpatient activities.
• Performs other related duties and projects as assigned.
• Adheres to ACFC policies and procedures.
• Supports and carries out our Mission & Values

Qualifications

Position Qualifications/Requirements:
Education and Training: Associates RN degree required, Bachelor’s degree preferred.
Experience:
• Two years of experience in managed care quality assurance or utilization review. preferred
• RN must have two years of experience in an acute care hospital.

Additional Information

Life Science Recruiter

Integrated Resources, Inc.

DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549