RN-Utilization Nurse

Company: Tailored Management
Location: Bedford
Posted on: February 20, 2021

Job Description:

Schedule: Mon-Fri 8:00AM-5:00PM Contract: 2/24/2020 - 9/04/2020 Duties: -Delivers specific tasks assigned by a supervisor in the Utilization Management job family. -Evaluates services provided to plan members are medically necessary. -Develops and maintains knowledge of provider organization review procedures. -Maintains reporting system for Utilization Review. -Completes day-to-day Utilization Review tasks without immediate supervision, tasks involve a degree of forward planning and anticipation of needs/issues. -Resolves non-routine issues escalated from more junior team members. Skills: -Strong clinical knowledge -Knowledge of ICD-10 and CPT coding guideline -Demonstrates strong verbal and written communication skills, negotiations and interpersonal skills. -Shows leadership (organizational) skills in team orientation, problem-solving, decision-making, conflict resolution, and the ability to work independently. -Experience with Medicaid and insurance processing and coding, strongly preferred. -Demonstrated organizational skills, time management, detail orientation, flexibility and ability to work with minimal supervision. -Strong interpersonal skills -Intermediate knowledge with Microsoft Office including Outlook, Word, Excel, and PowerPoint Education: Registered Nurse (RN) with no restrictions 5 years clinical experience 3 years in utilization review/discharge planning

Keywords: Tailored Management, Bedford , RN-Utilization Nurse, Healthcare , Bedford, Texas