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Nurse

Tampa, FL
Position Summary:
The Utilization Management Nurse Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making.
The Utilization Management Nurse Reviewer works with healthcare providers to ensure appropriate approval of plan benefits. This is accomplished by reviewing clinical information provided to assess medical necessity and the appropriateness of the treatment setting through the application of appropriate policies and criteria (i.e. Milliman). Case assignments may fall in various areas, such as  concurrent review of inpatient services, discharge planning, retrospective review, and  special needs facilities (SNF).
Minimum Qualifications:
  • Current Active and Unrestricted Nursing License required ( Associate Degree, Nursing Diploma  or Bachelor’s degree in Nursing)
  • 3 years combined clinical and utilization management experience in a managed health care plan preferred
 
Regards,

Rahul Yadav
(408) 560-3956
rahul@reqroute.com

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ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law. (www.reqroute.com)

 
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