The purpose of this position is to ensure that Archcare Community Life MLTC members obtain timely, cost-effective, quality care in the appropriate setting.
The primary role of the Utilization Review (UR) Nurse is to conduct timely review of service requests to assure that our members receive all appropriate services in compliance with medical and regulatory guidelines.
In all areas, the UR Nurse is charged with managing the delivery of care in an effective, professional and compassionate manner.
Collaborate with multiple business parties to ensure timely resolution of service requests.
Follow Archcare policies and procedures and departmental process. Adhere to business code of conduct.
Responsibilities include, but are not limited to, review and authorization of service requests.
Associate degree required.
Bachelors degree preferred.
2 years prior utilization management experience required.