- Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time.
- Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.
- Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
- Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team.
- Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
- Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care. Maintains department productivity and quality measures.
- Attends regular staff meetings.
- Assists with mentoring of new team members.
Job Type: Contract
Pay: $41.00 - $44.00 per hour
- nursing: 1 year (Preferred)
- Registered Nurse (RN) (Preferred)