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Registered Nurse - Utilization Review

Company:
K.A. Recruiting, Inc.
Location:
Portsmouth, New Hampshire, 03801, United States
Posted:
August 08, 2019

Description:

Full-time Utilization Review Nurse/RN Case Manager needed at a school providing ground-breaking services to children and adults with disabilities!

Position Title: Utilization Review Nurse/RN Case Manager

Reports to: Director Clinical Services

SCOPE: Responsible for determining medical necessity, appropriateness of care, level of care, and quality of care medical reviews for patients in accordance with all state mandated regulations and insurance company contracts program.

QUALIFICATIONS:

* Current RN license issued by the State of New Hampshire Board of Nursing

* Strong knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered services

* Strong knowledge of InterQual/Milliman,MCG, ICD 10 Codes, and MCG Criteria

* Strong in Microsoft Office

* Working knowledge of behavioral health, substance abuse and human service resources.

* Case Management certification desired

SCHEDULE: Monday–Friday 8:00-4:00

On-Call rotation for after hour’s coverage

Flexibility as program needs dictate

Offering competitive compensation and benefits!

For more information, please submit your resume for review.