RN Utilization Review & Case Management Specialist

kozmetickesluzby.vecnakraska.sk - Jobboard; Reno (NV); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive Compensation & Generous Paid Time Off

Excellent Medical, Dental, Vision, and Prescription Drug Plans

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

kozmetickesluzby.vecnakraska.sk - Jobboard is looking for a skilled Utilization Review Nurse to join their team. This role involves reviewing clinical cases, coordinating resources for optimal health outcomes, and ensuring adherence to established criteria.

The ideal candidate will have a current nursing license and at least three years of experience in Utilization Review/Case Management, with proficiency in Interqual criteria. Benefits include competitive compensation, loan forgiveness programs, and comprehensive health plans.

Qualifications

• Minimum of three years of Utilization Review/Case Management experience.
• Recent working knowledge of Interqual criteria and Milliman Care Guidelines.
• Minimum of three years in clinical medical/surgical nursing practice.

Responsibilities

• Review and evaluate clinical cases against established criteria.
• Coordinate resources to promote optimal health benefits and outcomes.
• Measure and review performance outcomes and propose improvements.

Skills

Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ)

Attention to detail

Ability to analyze and interpret data

Effective communication skills

Experience in multi-tasking and problem-solving

Excellent computer skills

Education

Graduation from an accredited nursing education program

Valid license to practice in Nevada, Florida, and/or Texas

Job description

kozmetickesluzby.vecnakraska.sk - Jobboard is looking for a skilled Utilization Review Nurse to join their team. This role involves reviewing clinical cases, coordinating resources for optimal health outcomes, and ensuring adherence to established criteria.

The ideal candidate will have a current nursing license and at least three years of experience in Utilization Review/Case Management, with proficiency in Interqual criteria. Benefits include competitive compensation, loan forgiveness programs, and comprehensive health plans.