Utilization Management Nurse – Care Optimization

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

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.