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Utilization Review Nurse

Company: Corizon Health
Location: Franklin
Posted on: July 12, 2019

Job Description:

Utilization Review Nurse Corizon Health is the pioneer provider of correctional healthcare in the United States. We are a company built on more than 40 years of innovation and expertise in the industry. Our people, our practices, and our commitment to success are the traits that make us the ideal employer as you begin or continue to advance your correctional healthcare career. We need you to be responsible for the implementation of a comprehensive outpatient/inpatient review process utilizing criteria based review standards and standards of best practice.A facilitator of quality health care intervention recommendations.Ability to manage a variety of caseload situations and maintain the caseload, as required. Review and assess over/under utilization issues. Track, trend and evaluate appropriateness and quality of care issues with the implementation of education to internal and external customers and process improvement initiatives.Respond to inquiries by provider/site employees relating to standards of care and best practices.Highly competent with working relationships UM Medical Directors/contract Medical Directors. Develop and maintain pre-established review parameters under UM Medical Director/contract Medical Director lead. Identify and document comparisons with community standards, regionally based as indicated.Communicate and document any issues relating to the outpatient/inpatient UM process to the Manager of Utilization Management. Assist with the data collection and reporting related to the UM outpatient/inpatient process. Participate in CEU offerings/seminars to enhance professional growth and development and the maintenance of nursing license. Registered Nursing LicensureYou will have 3-5 years experience in utilization management, case management, quality management.You will have experience with InterQual and/or Milliman Care guidelines.Strong organizational and time management skills.Experience with both Inpatient and Outpatient review process preferred. You will know how to work within computer systems such as spreadsheets, email, and medical records systems. Corizon offers you the following: Paid Time OffMedical, Dental and Vision InsuranceTuition Assistance401(k) with Company MatchComprehensive On-boarding This position may require a background check, security clearance, and/or drug screening. Category: Healthcare , Keywords: Registered Nurse (RN)

Keywords: Corizon Health, Franklin , Utilization Review Nurse, Healthcare , Franklin, Tennessee

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