Utilization Review RN

Utilization Review RN

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

• Evaluate clinical information submitted by providers against plan review criteria and benefit guidelines

• Utilize clinical information to determine if criteria for medical necessity and benefit guidelines are met

• Document pertinent case information for approvals and denials- refer cases failing to meet Interqual to Medical Director

• Act as liaison to ensure services are provided in the least restrictive, most cost effective and clinically appropriate setting

• ID and resolve problems that could interfere with provider’s continuity and coordination of care of members- refer unresolved problems to the manager

Qualifications

• Clear and active RN license in state of PA

• Minimum AS in nursing

• 2 years’ experience in acute care hospital AND

• 2 years’ experience in managed care, quality assurance or utilization review setting

Additional Information

Hours for this Position:

40 hours a week

M-F, daytime hours

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience

• Benefits offered, Medical, Dental, and Vision

• Fun and positive work environment

• Right to Hire opportunity

• Can start as early as next week

Interested in being considered?

If you are interested in applying to this position, please contact Steph Zymowski at 407-636-7030 ext.220 and click the Green I’m Interested Button to email your resume.