Utilization Management RN | Care Optimizer & Payer Liaison

1 Legacy, Inc; Clovis (NM); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider in Clovis, New Mexico, is seeking a skilled nursing professional to join their team. The role involves determining the correct level of care, conducting medical record reviews, and improving service utilization. Candidates should have a current state licensure, BLS certification, and at least three years of experience, including one in Utilization Management. Join a dedicated team committed to enhancing patient quality of life and professional practice standards.

Qualifications

• Current State Licensure required.
• BLS certification necessary.
• Minimum 3 years experience required, including 1 year in Utilization Management.

Responsibilities

• Responsible for determining the correct level of care.
• Performs medical record reviews for severity of illness.
• Conducts performance improvement activities.
• Monitors patient care and resource utilization.

Skills

Ability to work in changing environment

Ability to prioritize independently

Ability to work under stressful conditions

Experience with medical record reviews

Interacting with external review agencies

Education

Current State Licensure

BLS

Job description

A leading healthcare provider in Clovis, New Mexico, is seeking a skilled nursing professional to join their team. The role involves determining the correct level of care, conducting medical record reviews, and improving service utilization. Candidates should have a current state licensure, BLS certification, and at least three years of experience, including one in Utilization Management. Join a dedicated team committed to enhancing patient quality of life and professional practice standards.