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Job Summary:
The
Utilization Management Nurse is
responsible for utilization management,
utilization review, and concurrent
review. The UM Nurse will perform
reviews of current inpatient services,
and determine the medical
appropriateness of inpatient and
outpatient services following evaluation
of medical guidelines and benefit
determination.
Job
Description:
The
Utilization Management Nurse will perform
all or some of the following Job
description:
-
Assess and interpret customer needs
and requirements
-
Identify solutions to non-standard
requests and problems
-
Solve
moderately complex problems and/or
conducts moderately complex analyses
-
Work
with minimal guidance; seek guidance
on only the most complex tasks
-
Translate concepts into practice
-
Provide explanations and information
to others on difficult issues
-
Coach, provide feedback, and guides
others
-
Act
as a resource for others with less
experience.
Minimum Requirements / Knowledge / Skill
For Utilization Management Nurse Job
-
Demonstrated ability to successfully
work as part of a team
-
Computer proficiency
-
Previous utilization review and/or
case management experience
-
Knowledge of Milliman or Interqual
criteria
-
3 + years of hands-on clinical
experience.
Minimum Education Requirements /
Certification / Licensure For
Utilization Management Nurse Job
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