Registered Nurse | Utilization Management Appeals Nurse | Remote | Contract

Overview

Remote
Depends on Experience
Contract - W2

Job Details

Registered Nurse | Utilization Management Appeals Nurse | 3+ Years of Experience | Remote | New Jersey | Contract

Walker Healthforce is seeking a Utilization Management Appeals Nurse with 3+ Years of Experience to support a Healthcare Client based out of New Jersey This is a 6 month Contract opportunity.

RATE RANGE: 38 - 46 hourly
HOURS/SCHEDULE: Monday - Friday 8am -5pm EST
WORKER TYPE: W2

CORE REQUIREMENTS:

 

 

  • Active Unrestricted RN License NJ or Compact

  • Requires a minimum of two (2) years clinical experience.

  • Requires an associate’s or bachelor’s degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school.


ADDITIONAL REQUIREMENTS:

  • Must be local to New Jersey, New York, Connecticut, Delaware or Pennsylvania 


WE CONSIDER IT A BONUS IF YOU ALSO HAVE:

 

 

  • 3 - 5 years of experience with a background in either Utilization Management, Prior Authorization – Medical Surgical (Inpatient or Outpatient), Complex Case Management w/ exposure to UM, Concurrent or Retrospective Medical Policy Review.

  • Familiarity interpreting Milliman Care Guidelines MCG guidelines and CareRadius platform exposure is also desirable.

  • Health Insurance Payer experience preferred, however will accept Health System Utilization Management related experience.

  • Working knowledge of case/care and utilization management principles.

  • Basic knowledge of health care contracts and benefit eligibility requirements.

  • Knowledge of hospital structures and payment systems.


JOB RESPONSIBILITIES:

  • Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.

  • Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.

  • Coordinates and assists in implementation of plan for members.

  • Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.

  • Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.

  • Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.

  • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.

  • Encourages member participation and compliance in the case/disease management program efforts.

  • Documents accurately and comprehensively based on the standards of practice and current organization policies.

  • Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.

  • Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.

  • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.


WHAT WE OFFER: 

  • Competitive compensation package

  • Weekly pay via Direct Deposit

  • Medical, Dental & Vision available

  • 401k options


WHY WORK WITH WALKER? 

  • Access to our top ranked team of recruiting and placement specialists

  • Continuous, one-on-one support from a dedicated engagement manager

  • Professional resume development and interview preparation


Contact our Recruiting Team today to experience the Walker Healthforce difference!

ABOUT US:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!

We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.

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