Utilization Review RN

Healthcare Support Staffing; Indianapolis (IN); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Fun and positive work environment

Medical benefits offered

Job summary

A leading healthcare recruiting firm in Indianapolis is seeking an experienced RN to ensure high-quality care and manage medical necessity for services. The role requires a clear RN license in Indiana, 2 years of acute care experience, and strong computer skills. You will work closely with facilities and provide essential care coordination. This position offers a fun work environment and medical benefits. Interested candidates are encouraged to apply now.

Qualifications

• Must have a clear and active RN license in the state of IN.
• AS/BS in Nursing or combination of education/experience required.
• 2 years of experience in an acute care clinical environment.
• Strong computer skills/ability to navigate multiple systems.

Responsibilities

• Ensure medically appropriate, high quality, cost-effective care.
• Work with facilities and providers for care coordination.
• Conduct pre-certification and appropriateness of treatment reviews.

Skills

Clear and active RN license in the state of IN

Strong computer skills

Ability to navigate multiple systems (MS Outlook/Word/Excel)

Education

AS/BS in Nursing or combination of education/experience

Job description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs, or community resources.
• Applies clinical knowledge to work with facilities and providers for care coordination.
• Works with medical directors in interpreting appropriateness of care and accurate claims payment.
• May also manage appeals for services denied.
• Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

Qualifications

• Must have clear and active RN license in the state of IN
• AS/BS in Nursing or combination of education / experience
• 2 years of experience in an acute care clinical environment
  
• Strong computer skills/ability to navigate multiple systems (MS Outlook/Word/Excel)
  

Additional Information

Advantages of this Opportunity:

• Fun and positive work environment
  
• Medical benefits offered

Interested in being considered?

• Apply now for immediate consideration! You may contact Christine Morta at [phone].