Utilization Management Nurse-1

C018 MUSC Community Physicians (MCP); United States; On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health insurance

Employer Sponsored Retirement Plan

Paid time off and extended sick leave

Paid Parental Leave

Disability insurance plan options

Continuous professional and clinical培训

Competitive pay

Annual Merit Increase

Wellbeing resources

Tuition Reimbursement

Employee perks and discounts

Employee referral program

Flexible schedule options

Certification incentive program

Job summary

MUSC Community Physicians (MCP) is an entity within MUSC that supports rural health networks in South Carolina. This RN utilization management role involves reviewing care, monitoring patient charts, and coordinating with physicians to ensure appropriate treatment within insurer guidelines.

Qualified candidates hold a Bachelor’s in Nursing, an SC RN license, and 3+ years of RN experience, with leadership and strong communication skills. Competitive benefits accompany a full-time schedule.

Qualifications

• Bachelor's degree in Nursing and three years’ RN work experience.
• SC or compact-state RN licensure required.
• Excellent verbal and written communication skills.
• Familiarity with InterQual or Milliman screening criteria.

Responsibilities

• Conduct utilization reviews to determine care appropriateness.
• Monitor patient charts and records to evaluate concurrent care.
• Review treatment plans and insurer approvals.
• Collect and comply with data per policies and regulations.
• Consult with physicians as needed.

Skills

Utilization Review

Nursing

Leadership

Communication

Policy Compliance

Education

Bachelor's in Nursing

RN Licensure

Tools

InterQual/Milliman criteria

Job description

Job Description Summary MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina (MUSC) that provides healthcare to patients within the rural health network throughout the state of South Carolina.

Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition.

Entity MUSC Community Physicians (MCP) Worker Type Employee Worker Sub-Type Regular Cost Center CC005921 MCP - Utilization Management Pay Rate Type Hourly Pay Grade Health-28 Scheduled Weekly Hours 32 Work Shift

Job Description Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition.

Monitors patient charts and records to evaluate care concurrent with the patients treatment.

Reviews treatment plans and status of approvals from insurers.

Collects and complies data as required and according to applicable policies and regulations.

Consults with physicians as needed.

Bachelor's degree in Nursing from an accredited school of nursing and three years’ work experience as a Registered Nurse required.

Prior leadership experience preferred.

One year of case management and/or utilization management work experience preferred.

Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement.

Must possess excellent verbal and written communication skills.

Familiarity with InterQual or Milliman and Robinson screening criteria desired.

Licensure as a registered nurse by the state of South Carolina or compact state required.

Additional Job Description

Benefits

• Health, dental, vision, and life insurance
• Employer Sponsored Retirement Plan
• Paid time off and extended sick leave
• Paid Parental Leave
• Disability insurance plan options
• Continuous professional and clinical training
• Competitive pay
• Annual Merit Increase
• Wellbeing resources
• Tuition Reimbursement
• Employee perks and discounts
• Employee referral program
• Flexible schedule options
• Certification incentive program

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer.

MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations.

All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees.

For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees

Thank you for wanting to be part of the Medical University of South Carolina team. Whether you want to teach the next generation of health care leaders, innovate new business models, discover the next breakthrough or provide patient care, there's a role for you that fuels your passion and takes advantage of your skills.

There are career opportunities available in academics, research, hospital medicine, physician practices and support services, from patient billing to IT.

As an applicant, you can search jobs for all MUSC entities as well as search by category and location.

MUSC attracts more than $250 million annually in research funding, making it the biggest magnet for biomedical, extramural research dollars of all institutions of higher learning in South Carolina.

The Clinical and Translational Science Award (CTSA) Program aims to advance clinical and translational science to increase the speed at which new treatments become available to patients.

MUSC Health, the clinical enterprise, operates a 750 bed medical center, which includes a nationally recognized Children’s Hospital, the Ashley River Tower (cardiovascular, digestive disease, and surgical oncology), Hollings Cancer Center (one of fewer than 70 elite National Cancer Institute designated centers), a Level I Trauma Center and the Institute of Psychiatry.

In addition, there are more than 100 outreach clinics, hospital/health system affiliations, and telehealth sites.

U.S. News & World Report placed us among the top one percent of all American hospitals, with 11 specialties in the top 50.

The MUSC Medical Center is also one of only three Magnet designated hospitals in South Carolina.