Utilization Review Nurse - 257945

Medix™; Florida; On-site; USD 85,000 - 110,000; Full time

Job summary

Medix is seeking an experienced Registered Nurse in Florida to perform utilization review, review medical records, and consult with care providers to determine appropriate treatment based on current research.

The ideal candidate holds US RN licensure (or compact state license), a nursing degree, 1+ year in utilization review within managed care, and 1+ year acute care clinical practice; willingness to obtain additional state licenses.

Qualifications

• Active, unrestricted RN licensure from the United States in a state, OR a compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
• Associate degree or bachelor's degree in Nursing from an accredited school of nursing.
• MCG or InterQual tooling experience.
• Ability to obtain additional state licenses to meet business needs.

Responsibilities

• Perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed.
• Make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

Skills

Active RN license (US)

Ability to obtain additional state Lic

Education

Nursing degree (ADN/BSN)

Tools

MCG tooling

InterQual tooling

Job description

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

Required Skills

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
• Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing
• MCG or InterQual tooling experience
• Ability to obtain additional state licenses to meet business needs
• 1+ year of utilization review experience in a managed care setting
• 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)

Preferred Skills

• BSN
• Previous experience conducting concurrent or inpatient reviews for a managed care plan