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applicants
Utilization Review Nurse
at JI Companies in Austin, TX
Position Summary:
The Utilization Review Nurse is responsible for conducting prospective, concurrent and/or retrospective utilization review of specified health care services so that medical necessity, appropriateness of setting, cost-effectiveness and optimal patient management is ensured. This is a staff position that requires clinical experience, critical thinking and problem solving skills, collaboration with internal team members and health care professionals, and effective written and oral communication skills. Duties include prospective, concurrent and/or retrospective utilization review of specified health care services in accordance with established standards of practice, department protocol and the Texas Department of Insurance rules and regulations.
Functions & Responsibilities:
-Maintains confidentiality of patient and client information
-Assists with orientation of JI team members, physician advisors, health service providers and patients to utilization review and case management processes
-Conducts prospective, concurrent and/or retrospective review of health care services through the application state statutes and regulation and established standards of care
-Performs discharge planning and coordinates supportive health services to promote optimal medical management
-Refers pre-authorization requests to physician advisors when established guidelines do not address medical request
-Compiles and enters patient-related data into established systems for timely and accurate documentation of patient activity, analysis of medical history and utilization patterns
-Analyzes patient-related data to identify and recommend actions that promote optimal patient management
-Adheres to department objectives, quality management initiatives, and budget parameters
-Collaborates with internal team members to achieve JI strategic objectives and program goals
-With the assistance of the Market Management and Utilization Management teams, guides physicians in their awareness of preferred contracts, providers, and facilities.
Requirements:
-Associate’s degree (A.A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience; Bachelor’s degree (B.S.) preferred
-Valid and unrestricted RN or LVN licensure to practice as recognized by the state Board of Nurse Examiners
-A minimum of two (2) years experience in a clinical setting required (ER, Post-Op, Medical-Surgery, or Rehabilitation experience helpful)
-Familiarity with health care delivery systems, utilization review and managed care methodology preferred
-One year utilization review experience preferred
-Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations; ability to write reports, business correspondence, and procedure manuals; ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public; ability to read, analyze and interpret common scientific and technical journals, financial reports, and legal documents; ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community; ability to read, analyze and interpret the most complex documents; ability to respond effectively to the most sensitive inquiries or complaints
-Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; ability to compute rate, ratio, and percent and to draw and interpret bar graphs
-Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists; ability to interpret a variety of instructions furnished in written, oral, diagram, or scheduled form
-Basic competency with MS-Office software applications
-Familiar with web based data entry systems and customized systems to process work
-Strong customer service skills to include empathy, listening and problem resolution
-Must be able to prioritize, plan, and manage multiple tasks/demands simultaneously
-Effective written and verbal communication skills
-Strong organization and time management skills
-Ability to lift up to 10 pounds
-Must have close vision (clear vision at 20 inches or less), color vision (ability to identify and distinguish colors), and ability to adjust focus (ability to adjust the eye to bring an object into sharp focus)
If you are interested in learning more about JI Companies and applying for this position, please visit our website at www.jicompanies.com. EOE.
The Utilization Review Nurse is responsible for conducting prospective, concurrent and/or retrospective utilization review of specified health care services so that medical necessity, appropriateness of setting, cost-effectiveness and optimal patient management is ensured. This is a staff position that requires clinical experience, critical thinking and problem solving skills, collaboration with internal team members and health care professionals, and effective written and oral communication skills. Duties include prospective, concurrent and/or retrospective utilization review of specified health care services in accordance with established standards of practice, department protocol and the Texas Department of Insurance rules and regulations.
Functions & Responsibilities:
-Maintains confidentiality of patient and client information
-Assists with orientation of JI team members, physician advisors, health service providers and patients to utilization review and case management processes
-Conducts prospective, concurrent and/or retrospective review of health care services through the application state statutes and regulation and established standards of care
-Performs discharge planning and coordinates supportive health services to promote optimal medical management
-Refers pre-authorization requests to physician advisors when established guidelines do not address medical request
-Compiles and enters patient-related data into established systems for timely and accurate documentation of patient activity, analysis of medical history and utilization patterns
-Analyzes patient-related data to identify and recommend actions that promote optimal patient management
-Adheres to department objectives, quality management initiatives, and budget parameters
-Collaborates with internal team members to achieve JI strategic objectives and program goals
-With the assistance of the Market Management and Utilization Management teams, guides physicians in their awareness of preferred contracts, providers, and facilities.
Requirements:
-Associate’s degree (A.A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience; Bachelor’s degree (B.S.) preferred
-Valid and unrestricted RN or LVN licensure to practice as recognized by the state Board of Nurse Examiners
-A minimum of two (2) years experience in a clinical setting required (ER, Post-Op, Medical-Surgery, or Rehabilitation experience helpful)
-Familiarity with health care delivery systems, utilization review and managed care methodology preferred
-One year utilization review experience preferred
-Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations; ability to write reports, business correspondence, and procedure manuals; ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public; ability to read, analyze and interpret common scientific and technical journals, financial reports, and legal documents; ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community; ability to read, analyze and interpret the most complex documents; ability to respond effectively to the most sensitive inquiries or complaints
-Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; ability to compute rate, ratio, and percent and to draw and interpret bar graphs
-Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists; ability to interpret a variety of instructions furnished in written, oral, diagram, or scheduled form
-Basic competency with MS-Office software applications
-Familiar with web based data entry systems and customized systems to process work
-Strong customer service skills to include empathy, listening and problem resolution
-Must be able to prioritize, plan, and manage multiple tasks/demands simultaneously
-Effective written and verbal communication skills
-Strong organization and time management skills
-Ability to lift up to 10 pounds
-Must have close vision (clear vision at 20 inches or less), color vision (ability to identify and distinguish colors), and ability to adjust focus (ability to adjust the eye to bring an object into sharp focus)
If you are interested in learning more about JI Companies and applying for this position, please visit our website at www.jicompanies.com. EOE.
Published at Nov-12-2009
Viewed: 142 times
Viewed: 142 times