Utilization Management Nurse

Job Details

GA, Atlanta - Atlanta Regional Office - Atlanta, GA

Per Diem

Associate's Degree

Day

Nursing Professional & Support

Description

We are currently seeking a per diem Utilization Review Nurse.

The Utilization (UM) Nurse performs the review of requests for prior authorization of medical services, including diagnostic, outpatient care and services using defined criteria. Duties will include admissions through on-site and telephonic review to ensure medical necessity and appropriate level of care, review and audit of patient medical records as indicated to determine medical necessity, assistance in completion of Medicaid applications for patients currently hospitalized and serving as a clinical resource and liaison for site and hospital referral staff.

Qualifications

GA or compact RN license

Utilization management experience, InterQual experience preferred

Two (2) years of clinical nursing experience and one year of experience in performing prior authorization review

Experience using medical management software programs

Experience working with a correctional institution or agency preferred

Must be able to pass background investigation and obtain agency security clearance

We offer excellent compensation and comprehensive benefits for our full-time team members including:

Health, dental, vision, disability and life insurance

401(k) with company match

Generous paid time off

Paid holidays

Flexible Spending Account

Continuing Education benefits

Much more...

For more information, please contact Chris Genova at or