What are the responsibilities and job description for the Utilization Nurse RN position at TotalMed Medfi?
Utilization Nurse Responsibilities:
- Ensures diagnosis matches ICD9 codes.
- Conduct UM/care management (CM) review activities with delegated entities as necessary.
- Manages member treatment in order to meet Recommended Length of Stay.
- Ensures discharge(DC) planning at levels of care appropriate for the members needs and acuity.
- Determines discharge (DC) plan by assessing cognitive and physical status.
- Determines post-acute needs of patient, levels of care, equipment, how event is going to impact patients status.
Utilization Nurse Requirments:
- Current active CA RN License required.
- Bachelors of Science Degree in Nursing preferred.
- Proficient knowledge of NCQA, URAC, federal and state requirements
- Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care, and length of stay criteria sets desirable.
#INDPM
Job Type: Full-time
Pay: $46.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Education:
- Bachelor's (Required)
Experience:
- Utilization review: 1 year (Required)
- NCQA, URAC: 1 year (Required)
- acute clinical: 3 years (Preferred)
- utilization management: 1 year (Preferred)
License/Certification:
- RN (Required)
Work Location: Remote
Salary : $46 - $0
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