Centers Plan for Healthy Living

RN Utilization Management Nurse

US-NY-Staten Island
7 months ago
ID
2017-1161
# of Openings
1
Category
Nurses

Overview

 

Responsibilities

  • Authorization of medically necessary services in coordination with the care management department. Review of care management documentation and outcomes evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs.
  • Ensures that the services required for the plan of care is met in partnership with the person centric process which may include his/her significant other, primary caregiver, the primary and attending physicians, and various other providers and support involved in the member’s care.
  • Provides utilization review for preauthorization, concurrent and discharge reviews and post service review
  • Utilizes knowledge of community resources and the member’s benefit structure
  • Recognizes quality of care issues and escalates the issues appropriately
  • Have a knowledge of the Appeals and Grievances process
  • Assists members with the coordination of services from various settings as appropriate
  • Participates in case rounds as a member of the Integrated Care Team
  • Participates in on call scheduling
  • Participates in quality improvement initiatives

 

Qualifications

  • Active and unrestricted NYS RN license, BSN preferred
  • Minimum 2 years Utilization Management experience in a hospital
  • Strong written and verbal communication skills
  • CCM certification preferred
  • Knowledge of Milliman or InterQual criteria preferred
  • Microsoft Applications Proficiency (Word, Excel, Outlook)  

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