Collabera
Nurse - Utilization Review Job at Collabera in Baltimore
Collabera, Baltimore, MD, United States
Description
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Nurse - Utilization Review
Contract: Baltimore, Maryland, US
Salary: $45.00 Per Hour
Job Code: 356120
End Date: 2024-12-20
Days Left: 26 days, 2 hours left
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About the Role:
- The Utilization Review Specialist will be responsible for performing prospective, concurrent, and retrospective reviews for authorization, appropriateness of care determination, and benefit coverage.
- This role will require leveraging clinical expertise and critical thinking skills to analyze clinical information, contracts, mandates, and medical policies to contribute to the determination of appropriateness and authorization of clinical services.
- Determine medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, and medical references.
- Conduct research and analysis of diseases, treatments, and emerging technologies to support decisions and recommendations made to medical directors.
- Collaborate with various departments to determine appropriate benefit application.
- Make appropriate referrals and contacts as needed.
- Offer assistance to members and providers for alternative care settings.
- Research and present educational topics related to cases, disease entities, and treatment modalities.
- Bachelor's Degree in Nursing
- 5 years of clinical nursing experience
- 2 years of care management experience
- In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required
- Working knowledge of managed care and health delivery systems
- Thorough knowledge of clinical guidelines, medical policies, and accreditation standards
- Familiarity with web-based software applications
- Strong written and interpersonal communication skills
- Proficient in assessment skills and making rapid connections with members telephonically
- Utilization Review
- clinical
- care management
- managed care
- RN
- LPN
- Registered Nurse
- Licensed Practical Nurse
- Clinical review
- Recruiter
- Phone
- Rohan Lazarus
- rohan.lazarus@collabera.com
Apply Now