Utlization Review Nurse

US-NY-New York
3 weeks ago(12/28/2017 11:55 AM)
Job ID
2017-11183
# Positions
1
ArchCare Community Life
Experience (Years)
5
Category
Care Management
Work Days Per Week
5
Shift
D
Shift Start Time
9:00am
Shift End Time
5:00pm
Type
Full-Time
# Hours
35

Overview

The purpose of this position is to ensure that Archcare  members obtain timely, cost-effective, quality care in the appropriate setting. The primary role of the Utilization Review (UR) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that our members receive all appropriate medical services in compliance with medical and regulatory guidelines. Responsibilities include, but are not limited to, review and authorization of Outpatient Services. review of requests for pre-authorization of elective admission and procedures. inpatient admission review. review of continuing stay and discharge planning. and coordination of care and services of select member populations with common chronic conditions. In all areas, the UR Nurse is charged with managing the delivery of care in an effective, professional and compassionate manner.

Responsibilities

 

Qualifications

Required Education Experience o Associates Degree in Nursing or Diploma in Nursing with at least five years of nursing experience required. Registered Nurse with a Bachelors Degree in Nursing preferred.

Experience Requirements

Current licensure as a Registered Nurse or licensure as a Practical Nurse in New York State

Skill Requirements

 

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