Utilization Management Nurse
: Job Details :

Looking to add a UM nurse to our team. Would like this position to start as soon as possible. MUST HAVE have Concurrent Review Experience, preferably from the health plan side, and even better for a Medicare Advantage Plan.Duties:Conduct telephonic reviews for inpatient facilities for both concurrent and retrospective reviewsProcess Prior Authorization requests for medical necessity of Outpatient servicesGather clinical information to assess and expedite care needsCollaborate with providers to assess members, needs for early identification of and proactive planning for discharge, transfer and redirectionIdentify problems or needed changes, recommends resolution, and participates in quality improvement effortsMUST know this is a growing health plan, they have around 900 members now and it is a start up that will have growing pains. Must be ok with flexibility/change- but there is opportuntiy for growth.Must Have Skills/Qualifications:Active RN License (Must be Multi-state include AZ and FL)1-3 years' experience in Concurrent Review1+ years working with a healthplan2+ years of UM Nurse experienceMust have their own equipment (laptop/computer and headset)Nice to Have Skills:Medicare Advantage experienceBilingual in SpanishExperience with ESRD and/or dialysisFamiliarity with Medicare Guidelines and MCGSchedule/Shift:Monday-Friday 8AM-5PM (AZ MST)Benefits/Perks:Base pay + along with competitive benefits for yourself and your familyIncredible growth opportunities with an actively growing start upTop-notch training to keep you educated, informed, and up to date with industry trendsRegular one on one coaching and mentoring from Managers to improve your craft and reach your goalsClarity and collaborationMedicare based plan for renal disease5 plans and one MA planGROWTHPay: $36.94-$42.00/hr DOEMedix is acting as an Employment Agency in relation to this vacancy.