Utilization Management Registered Nurse
Correct Care Solutions |
Pompano Beach, FL
Our UM Nurse will assist with analyses of medical necessity, level of care, care progression, and resource utilization.
- Graduation from an accredited School of Nursing
- Previous experience working with utilization management
- Computer data entry experience
- Current licensure as a Registered Nurse
Utilizes nationally recognized evidence-based criteria to determine medical necessity of requested services, diagnostics, specialty care, or inpatient care.
Refers provider requests when the requested services do not meet the recognized criteria.
Coordinate with healthcare staff and providers to plan for discharge back to DOC institutions.
Reviews information to determine the level of care or the medical necessity of any services requested by a provider.
Reviews and audit inmate medical records to determine what services or procedures are medically necessary.
The above responsibilities are a highlight of responsibilities and not a full list. Other responsibilities may be performed as assigned.
CCS is an EOE/Minorities/Females/Vet/Disability Employer
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Job Code: 18-55896
Posted On: 09/28/18
Closing Date: Open Until Filled
Categories: Healthcare, Nursing, Management
Job Type: Regular
Job Status: Full Time
Additional Contact Info