Utilization Review Nurse

LanceSoft, Inc.; Detroit (MI); Remote; USD 60,000 - 80,000; Full time

Job summary

LanceSoft, Inc. is seeking a Recruitment Manager to manage medical necessity reviews and patient care coordination. The ideal candidate will have a nursing degree, relevant clinical experience, and familiarity with InterQual guidelines. This contract role offers competitive hourly pay and the opportunity to impact patient care processes in a dynamic healthcare setting.

Qualifications

• Two to four years of clinical experience including post-acute care and case management.
• Demonstrated clinical knowledge and experience with health care delivery processes.

Responsibilities

• Perform medical necessity reviews for post-acute care services and coordinate care.
• Provide support for members transitioning from post-acute care settings.

Skills

Clinical knowledge

Care coordination

InterQual experience

Education

Bachelor’s degree in nursing or related field

Job description

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This range is provided by LanceSoft, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$35.00/hr - $38.00/hr

Direct message the job poster from LanceSoft, Inc.

Recruitment Manager @ LanceSoft, Inc. | Building Successful Teams, Strategic Planning

Job Description

• Use established medical policy and guidelines to perform prospective, concurrent, and retrospective medical necessity review of post-acute care services to ensure medical necessity for appropriate setting, appropriate length of stay, including appeal requests initiated by providers, facilities and members.
• Will coordinate care through the health care continuum including member outreach.
• Provides support and alternative care support for members not appropriate for post-acute care service as well formulate discharge readiness for members transitioning from a post-acute care setting to a lower level of care.
• Should have experience with InterQual

Requirement:

• Bachelor’s degree in nursing, allied health, business, or related field preferred.
• Two to four years of clinical experience which may include post-acute care, home care, acute patient care, discharge planning, case management, and utilization review, and caring for aging population in the home or post-acute care setting, etc.
• Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes.
• One year health insurance plan experience or managed care environment preferred.
• Registered Nurse with current unrestricted Michigan Registered Nurse license required.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care and Insurance

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