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Utilization Management Nurse
Ref No.: 18-00431
Category: Permanent Placement
Location: New York, New York
Pay Rate : $ 85,000.00 - 85,000.00 /Year
Staff Title: Utilization Management Nurse
 
Reports to: Director of Utilization Review
 
Working Conditions: Full time (M-F) Office Based
 
Position  Summary:  Responsible  for  assuring  cost  efficient  outcomes  for  clients  and  evaluating  enrollee requests for inpatient and/or outpatient precertification/preauthorization for necessity. The UM Nurse will coordinate, monitor, evaluate, and approve plans of care and/or service requests in accordance with guidelines. The UM Nurse is able to work both independently and collaboratively with other members of the UM staff to assure timely and appropriate completion of assigned work in conformance with established departmental policies and standards.

Education:
  • Graduate from an accredited school of nursing. Associates or Bachelor's degree in nursing, or Bachelor's in an appropriate related field.
License:
  • An active and unrestricted license as a registered nurse (RN) 
Experience:
  • A minimum of three years clinical experience as a Registered Nurse in a clinical setting required. One year experience as a case manager or UM nurse in a payer or facility setting is also required
Certification:
  • Certified in Case Management or Utilization Management preferred