Medasource ยท 6 hours ago
Utilization Management RN
United States
Full-time
Remote
Entry, Mid Level
2+ years exp
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Hiring Manager
Lindsey T.
Insider Connection @Medasource
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Responsibilities
Perform telephonic review of prior authorization, concurrent reviews, and retrospective review requests for the appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for the other determinations
Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
Collaborate with various staff within provider networks and case management teams electronically or telephonically to coordinate member care
Educate providers on utilization and medical management processes
Provide clinical knowledge and act as a clinical resource to non-clinical team staff
Enter and maintain pertinent clinical information in various medical management systems
Qualification
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Required
Active RN License
Graduate from an Accredited School of Nursing
2+ years of clinical nursing experience
Preferred
Knowledge of healthcare and managed care preferred
Bachelor's degree in nursing preferred
Company
Medasource
Medasource is a hospital & health care company specializing in population health management and clinical engineering services.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Abimbola ojo
EPIC OPTIME/ ANESTHESIA Consultant at Ascension
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