Utilization Management NICU Nurse
Remote
RemoteFull TimeMedium
Full TimeMedium
Job Summary
Coordinate overall member care from pre-admission through concurrent review and outpatient services using a proactive, evidence-based decision-making process. Serve as a nurse reviewer for admissions, lengths of stay, and discharge planning while acting as a liaison between providers, hospitals, and health plans. Implement client-specific contracted policies, managed care policies, and benefits criteria guidelines. Identify and refer potential quality of care issues to the Medical Director, client, or appropriate staff.
Required Qualifications
- Clinical care (UM) nurse
- Nurse reviewer for admissions
- Nurse reviewer for lengths of stay
- Facilitator for discharge planning
- Liaison between providers, hospitals and health plans
- Implementation of client-specific contracted policies
- Implementation of managed care policies
- Knowledge of benefits
- Knowledge of criteria
- Knowledge of guidelines used for reviews
- Ability to identify quality of care issues
- Ability to refer quality of care issues to the Medical Director, client and/or appropriate staff
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