Previous Job
Previous
Utilization Management Nurse Consultant
Ref No.: 18-13656
Location: New Albany, Ohio
Start Date / End Date: 11/12/2018 to 01/11/2020
Duration:11-14 month(s)

Description/Comment:The UM Nurse Consultant reviews inpatient cases for medical necessity. Levels of care that are reviewed include acute inpatient hospital, LTACH (long term acute care), Acute Inpatient Rehab, and SNF (skilled nursing facility). Criteria utilized includes MCG and the Medicare Benefits manual. The UM nurse consultant collaborates closely with care managers and the medical directors.
-Telephonic utilization review of inpatient cases
-Reviews inpatient cases for medical necessity
-Utilizes MCG and the Medicare Benefits Manual for criteria
-Close collaboration with care managers and the medical directors
-Rewarding position obtaining care that our members need
-Close team environment
-3-5 years of clinical experience required
-Must work well independently and also in a group setting
-Must be a proficient typist using both hands. Weekend (once every 5 weeks approximately) and holiday (one holiday per year approximately) rotations are required. Possible temp to permanent position. Looking for candidates with longevity at places of employment (aka not a lot of job hopping).

Additional Job Details:CRITICAL NEED TO FILL ASAP. RN license required. Need to be within driving distance to the New Albany, OH office. Please include MS Office Package, Typing test, and Telephonic Etiquette test scores on resume to be considered. NOTE: Candidates can be submitted in the lower $30’s/hr range.