RN

 
Location: Troy, Michigan
Posted On: 3/15/2017
Job Code: 3456_TR_MO
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Job Description
 
Must Haves:
• UM experience
• Computer skills
• Licensed RN in the state of Michigan.

Essential Functions:
• Provides concurrent review and prior authorizations (as needed) according to client's policy for client's members as part of the Utilization Management team.
• Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
• Participates in interdepartmental integration and collaboration to enhance the continuity of care for client's members including Behavioural Health and Long Term Care.
• Maintains department productivity and quality measures.
• Attends regular staff meetings.
• Assists with mentoring of new team members.
• Completes assigned work plan objectives and projects on a timely basis.
• Maintains professional relationships with provider community and internal and external customers.
• Conducts self in a professional manner at all times.
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Consults with and refers cases to client's medical directors regularly, as necessary. Complies with required workplace safety standards. Knowledge/Skills/Abilities:
• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Knowledge of applicable state, and federal regulations.
• In depth knowledge of Interqual and other references for length of stay and medical necessity determinations.
• Experience with NCQA.
• Ability to take initiative and see tasks to completion.
• Computer Literate (MS Office Products).
• Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Skilled at establishing and maintaining positive and effective work relationships with co-workers, clients, members, providers and customers.

Required Education: Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree). Required Experience: Some clinical practice. Preferably hospital nursing, utilization management, and/or case management. Required Licensure/Certification: Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing.
Category:IT  code:new
 
 
Job Requirements
 
 
MS Office, Utilization Management and Interqual
 

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Contact Details
 
Recruiter
Nidhi Gupta
 
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