WHAT YOU'LL DO
- Assess inpatient services for behavioral health members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
- Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to medical directors for review depending on case findings.
- Educate providers on utilization and medical management processes.
- Ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
In-Office telephonic opportunity; NO REMOTE OPTIONS AVAILABLE!!
- Active RN / Registered Nurse License in Louisiana
- Associate Degree Required
- 2+ years of acute care/clinical experience
- Managed Care, Utilization Review OR Prior Authorization experience highly preferred
PLEASE CALL: Alliston Brown / 586-710-7944 or 877-782-3334, EXT 229
registered nurse, RN, insurance, utilization review, utilization management, concurrent review, prior authorization, health insurance, acute care, telephone, telehealth, managed care, insurance, health insurance, nursing, nursing
$86,153.60 - $86,153.60 /year