RN-Utilization Review Nurse
VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position, 9am-5pm. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services. This is a work from home position.
Some of your daily activities will include managing providers, members, team, or care manager generated requests for medical services and renders clinical determinations. You will deliver timely notification detailing clinical decisions and provide intervention to decrease delays and denials. As the Utilization Review Nurse you will collaborate with the Care Coordination Team to implement support for transitions in care, ensuring the timely processing for medical services that improve the quality and outcomes of care.
We would like to speak to those who have a current unrestricted NYS RN license to practice professional nursing, URAC preferred. Seeking those who bring a BSN (advanced degree preferred), along with 2+ years of utilization review experience at a Managed Care Organization or Health Plan required. Working knowledge of Medicaid and/or Medicare regulations as well as coverage guidelines and benefit limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines will be vital to this role.
There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys highly competitive compensation and benefits package, a 403(b) retirement plan and much more than we would love to speak with you! VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.
VillageCare is a Drug-free workplace. Equal Opportunity Employer
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