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RN/Utilization Review
Posted on Lycos Classifieds - 4 weeks ago
- Location:
- Albuquerque, NM
Features & Description
All Medical Personnel is currently seeking Registered Nurses interested in Utilization Review opportunities in Albuquerque, NM! We have been asked by our client to locate the "Best of the Best" Utilization Review Nurses for a great career opportunity!The selected candidates will be responsible for assessing and introducing wellness education to patients across New Mexico. Experience with telephonic case management is very helpful for this position. UR Nurses will also provide physician referrals based on information provided after wellness assessment. The UR Nurse will then review incoming requests for the following criteria:
Provide accurate disposition of prior authorization requests submitted by providers for Medicaid fee-for-service recipients, involving specific services through analysis of abstract submissions, medical records, orders and related documentation
Review and apply criteria, collect, research and organize information to use in reviews. Requests are for waiver services under the Disabled and Elderly Waiver
Review and determine appropriateness of level or care requests and plan of care requests for these waiver services
Appropriately refer reviews not meeting criteria to peer consultants, including medical directors
Refer potentially fraudulent claims to management for further investigation
Maintain complete confidentiality of protected health information
Maintain effective communication with management regarding development within areas of assigned responsibilities
Requirements
Unrestricted New Mexico RN License and three years clinical experience
Effective communication skills.
Time management skills.
We are looking to identify candidates quickly for this position so turn interest into action and apply today!
If you are interested in this position, please send your current resume in Word format to nichelew@allmedstaffing.com.
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