Tampa, Florida
Utilization Review Nurse Job Opening in Tampa, Florida - Conducts review of patient charts at contracted hospitals and clinics to determine if guidelines are met for select cases, where emergent enrollment is requested and for other cases requiring clinical judgment at the RN level.
Prepares and submits written findings and corrective action plan recommendations to the Division Director, Medical Management Vendor's Medical Director on non-compliance cases or those requiring a physician review.
Approves the purchase of durable medical equipment and supplies for assigned network clients to ensure quality of care and appropriate use of resources consistent with Medicare guidelines.
Refer patients to disease management or case management programs.
Conducts special utilization studies as directed by management.
Maintains work related records and reports where necessary.
Inputs utilization review determinations and related pre-certifications in the computer.
Performs medical case management of client within assigned network.
Performs other related duties as required.
This is a contract position, MUST train in Tampa, paid holidays currently no other benefits.
Job Type: Contract
Job Type: Contract
Required experience:
InterQual and or Milliman: 1 year
prior authorization: 1 year
RN: 3 years
Healthcare setting: 3 years
Required license or certification:
FL Registered Nurse (RN)
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