Honolulu, Hawaii
Utilization Management Review Nurse (273418) Job Opening in Honolulu, Hawaii - Job Title: Utilization Management Review Nurse
Industry: HealthCare
Duration: Direct Hire
Hours: Monday ? Friday, 8:00am ? 5:00pm.
Location: Honolulu, HI
Parking: Provided
Note: Applications will only be reviewed for applicants currently living in the state of Hawaii and who are available for an interview with Staffing Solutions.
Description:
Review referrals, member eligibility, benefit coverage, and member qualification to approved criteria.
Interface with Providers (physicians, DME, and other providers) to discuss issues and concerns with PA requests process and facilitate timely access to medically necessary health care services required by plan members.
Provide prior authorization and assist with denial reviews as well as facilitating short and long term options through interdepartmental communication and referrals for SMI, SEBD, ADRC and case management of members with specialized care or on disease management programs.
Provide timely computer entry of encounter information and data to maintain an accurate record of clinical reviews and services authorized and provided to Plan members.
Perform clinical review via phone or on site, and assignment of length of inpatient stay in accordance with all state and federal mandated regulations and company policy and procedure
Requirements:
RN or LPN currently licensed in the State of Hawaii
At least one year experience in UM
Ability to function independently and coordinate the work of other personnel effectively
Exhibit strong planning, organizational and time management skills
Basic computer knowledge
Must possess excellent verbal and written communication skills
Learn and develop experience in the use of information system, Western Region LOS, InterQual Criteria, QNXT and historical databases
Ability to conduct training with audiovisual presentations.
Pay: (Based on Experience)
ID# 273418
All offers are contingent upon the successful completion of background and reference checks.
Interested Applicants: Please visit us online at to view additional positions. Applications will only be reviewed for applicants currently living in the state of Hawaii and who are available for an interview with Staffing Solutions.
Staffing Solutions of Hawaii:
Staffing Solutions of Hawaii is a local, award winning, and growing privately owned agency in Oahu. For more than 20 years, our personal approach to building our relationships with renowned companies ensures our employees enjoy competitive pay, stimulating careers and assignments, and excellent growth opportunities, with the chance for it to turn into full-time employment!
We are proud to be an Equal Employment Opportunity and Affirmative Action employer, including females, minorities, protected Veterans and those with disability.
Job Type: Full-time
Job Location:
Honolulu, HI
Required experience:
utilization management: 1 year
Required license or certification:
Registered Nurse (RN)
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