Utilization Review Nurse

Utilization Review Nurse

23 Jul 2024
Ohio, Gahanna 00000 Gahanna USA

Utilization Review Nurse

Vacancy expired!

Description

All clinical positions are Full Time, On Site in our offices in Columbus

As a Utilization Review Nurse you are a key member of a cross-functional team driven by their mutual devotion to serve others. You advocate for your inpatient members during their hospital stay reviewing, processing and interfacing with providers when medical service requests are made. For smooth, timely processing; clinical documentation is fully and accurately completed the first time. And because you sincerely care for the experience of members, you proactively offer your expertise to other members of the team.

Bring your invaluable experience from Med/Surg, Cardiac, Oncology, Neurology, Surgical or other critical care nursing and our best-in-class training program will equip you for your next chapter as a healthcare warrior.

How can you make a lasting impact?

  • Assess and review all requests for inpatient medical services requiring clinical review against company adopted clinical review criteria
  • Take ownership of the full review process from initial to concurrent and retrospective
  • Facilitate the discharge process including arrangements for skilled nursing care, rehabilitation, home infusion and other outpatient ancillary services
  • Redirect out-of-network service requests to in-network providers to ensure maximum benefit to members, when possible
  • Actively research vague or questionable procedures and present findings to the Chief Medical/Physician Peer Reviewer for opinion
  • Provide timely notification to the Chief Medical/Physician Peer Reviewer of potential non-certifications
  • Effectively review diagnoses and make appropriate recommendations to Case Management
  • Coordinate with providers, facility and internal work groups regarding request outcomes
  • Effectively translate and communicate clinical messages to members with empathy and patience
  • Provide monitoring and oversight of non-clinical staff activities and provide clinical support during business hours

What do you need to succeed?

  • Active Registered Nurse or Licensed Practical Nurse license in Ohio
  • Minimum of 2 years direct patient care clinical experience required; preferably in a hospital setting
  • Experience in health management preferred
  • Confident clinical judgement with excellent critical thinking
  • Computer proficiency including using MS Office, navigating multiple programs simultaneously and accurate typing at speed

Full-time position requires successful completion, via testing, of 6 - 7 weeks of training Monday - Friday from 9:00 AM - 6:00 PM. Upon completion, available shifts will be within 9:00 AM - 8:00 PM, Monday - Friday as business needs dictate.

What’s in it for you?

  • Paid-time-off, paid holidays and weekends free
  • Comprehensive Medical/Dental/Vision insurance including domestic partner benefits
  • 401k with 4% match
  • On-site fitness facility, ping pong table, serenity room massage chairs
  • Education reimbursement after a year of service
  • Supportive Engagement Teams i.e. Women, LGBTQIA, etc.

Quantum Health nurtures an award-winning, highly-engaging culture that supports each member as an individual, provides continuous development opportunities and career growth. Our work is serious but our laid back, fun environment fuels each of our 1,200+ employees to make lasting impact on our members and families’ lives.

We are the healthcare warriors for nearly 200 businesses and their employees providing comprehensive guidance as they navigate their self-funded healthcare plans. Our work cuts costs, maximizes the benefits portfolio and achieves the best employee experience for each medical situation.

Quantum Health is an Equal Opportunity Employer

Job Details

  • ID
    JC14955659
  • State
  • City
  • Job type
    Full Time
  • Salary
    TBD
  • Hiring Company
    quantum-health
  • Date
    2021-04-19
  • Deadline
    2021-06-18
  • Category

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