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Utilization Review Nurse -Direct Hire

Sacramento, CA

Posted: 09/25/2018 Employment Type: Direct Hire Position Industry: Healthcare/Medical Job Number: 40076.1
We have a great opportunity for a Utilization Review Nurse to join a progressive Healthcare organization in Sacramento. The UR Nurse will be responsible for evaluating authorization requests and authorize, modify, or pend per appropriate criteria. The UR Nurse coordinates initial and ongoing assessments to ensure continuity of care through discharge. This is a direct hire opportunity!

Responsibilities: Responsible for managing continuous care from admission through discharge for assigned patients either inpatient or outpatient. Research andrefer members to sources for alternative funding, community services and other services. Coordinate care between PCP and other physicians and providers as needed. Identify cases for possible peer reviewers to evaluate the appropriateness and necessity of care and or quality of care concerns. Assure referrals are complete and eligibility benefits verified, prior to authorizing inpatient and outpatient care. Perform concurrent review for inpatient and/or outpatient and case management to ensure appropriateness of admission, continued inpatient/acute rehabilitation and discharge. Authorize home health visits as needed; arrange for admissions to ancillary medical facilities. Authorize outpatient services requested, determine medical necessity; specialty services.

Requirements: Graduated from an accredited school of nursing required. Current and Valid California Registered Nurse or Licensed Vocational Nurse required. 2 years' professional nursing experience in an acute care setting or outpatient setting preferred or; 2 years utilization/case management experience in the managed care industry. Exceptional verbal and written communication skills. Excellent critical thinking and analytical skills. Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers/members. Ability to multi-task, exercise excellent time management, and meet multiple deadlines. High attention to detail and ability to document information accurately. Proficient with Microsoft Office.

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