Registered Nurse - Utilization Review Specialist - SUNYWNYRN Job at NavitsPartners, Mount Morris, NY

dXZJZzBOeEJ5amx5cDdZcFNoeUk4R0FWOEE9PQ==
  • NavitsPartners
  • Mount Morris, NY

Job Description

Registered Nurse – Utilization Review Specialist

Qualifications:

  • Active Registered Nurse (RN) license in the state of employment.
  • Bachelor’s degree in Nursing (BSN) preferred.
  • Minimum of 2 years of experience in utilization review, case management, or quality assurance.
  • Knowledge of Medicare, Medicaid, and private insurance guidelines.
  • Strong analytical, critical-thinking, and decision-making skills.
  • Proficiency in electronic health records (EHR) and utilization management software.

Duties:

  • Conduct medical necessity reviews and ensure appropriate use of healthcare resources.
  • Collaborate with insurance providers to obtain authorizations and approvals.
  • Monitor patient length of stay and recommend discharge planning strategies.
  • Analyze clinical documentation for compliance with regulatory standards.
  • Work with physicians and healthcare teams to support cost-effective care.
  • Provide recommendations to improve utilization management processes.

Pay:

  • Medium weekly pay range: $2,000 - $2,500

Job Tags

Weekly pay,

Similar Jobs

Sapsol Technologies Inc

Entry-Level SAP MM Consultant , Remote Job at Sapsol Technologies Inc

 ...consistency. # Collaborate with technical teams to facilitate data exchange between systems. 4. Testing and Validation: # Develop and execute test scripts to validate system functionality. # Perform unit and integration testing, and work with end-users to... 

PwC

Cybersecurity, Privacy and Forensics- Strategy and Program Design - Senior Associate Save for Later Remove job Job at PwC

 ...you need to lead and deliver value at this level include but are not limited to:...  ...of Study : Computer and Information Science, Information CyberSecurity , Information...  ...PwC does not intend to hire experienced or entry level job seekers who will need, now or in... 

Forhyre

Medical Research Assistant Job at Forhyre

 ...Join Our Team as a Research Assistant Position: Research Assistant (Intern) Location: Fresno, CA Reports To: Research Manager(s) Classification: Intern Position Overview: We are seeking a passionate and motivated Research Intern to join our... 

1440 By The Bay

Medication Aide Job at 1440 By The Bay

 ...Employee Assistance Program Our community is looking for a Care/Medication Technician to join our team. The Care Giver/Med Tech role...  ...by the Supervisor. Qualifications: Certified Nurses Aid certification preferred. High School diploma/GED Must be... 

Slate

General Assembly Process Engineer Job at Slate

 ...electric vehicle space. Who we are looking for: We are looking for a highly skilled and detail-oriented General Assembly Process Engineer to join our dynamic team. The ideal candidate will be responsible for optimizing assembly processes, improving efficiency, and...