Registered Nurse Utilization Review (Intermountain Health)

Job Description

Job Description:

SelectHealth is a not-for-profit community health plan serving more than 1 million members in the intermountain west that offers a variety of Medicare, Medicaid, Marketplace Qualified Health Plans and commercial health plans. Utilization review behavior health professional proactively manage inpatient and outpatient utilization to assure that medical care is appropriate, efficient, and medically necessary.

Job duties include:

• Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.
• Applies evidence-based guidelines (e.g. InterQual) and medical policies with prior authorization and concurrent reviews and follows the applicable regulatory guidelines (NCQA, CMS) to provide clear and timely communication to members and requesting providers
• Identifies members for referral opportunities to integrate with other products, services and/or programs
• Collaborates with physicians, internal staff, members and members' families to assist in expediting appropriate discharge, obtains authorizations, and directs toward medically necessary care. Resolves member, family/caregiver assistance requests.

Minimum Qualifications

• Current RN license in state of practice.
• Three years clinical nursing experience.
View Orignal JOB on: nursingjobs.site
• One year in Managed Care, Utilization Management, or Case Management.
• Basic computer skills including word processing and spread sheets.
• Excellent organizational, written, and interpersonal skills and the ability to anticipate and solve problems and communicate clearly and effectively.
• RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion.

Preferred Qualifications

• Bachelor's degree in Nursing (BSN). Education must be obtained from an accredited institution. Degree will be verified.
• Current working knowledge of Medicare, Medicaid and Commercial insurance.
• Current working knowledge of utilization management and case management techniques.
• Working understanding of coding or utilization management criteria (i.e., InterQual, CMS manual).
• Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.

Physical Requirements:

Ongoing need for employee to see and read information, assess member needs and view computer monitors.
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Frequent interactions with providers, members that require employee to verbally communicate as well as her and understand spoken information, needs and issues accurately.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. 

$39.99 - $59.18

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

All positions subject to close without notice.