ID# 012852

RN Concurrent Review | InterQual

Category

Job Description


We're working on behalf of the largest company focused solely on meeting the health care needs of financially vulnerable Americans. Currently serving approximately 2.7 million members in 13 states nationwide, the company is dedicated to offering real solutions that improve health care access and quality for our members, while proactively working to reduce the overall cost of care to taxpayers. Together with its parent company's affiliated health plans, they serve more than 4.5 million beneficiaries of state sponsored health plans in 20 states, making them the nation's leading provider of health care solutions for public programs.
We seek a Registered Nurse with three (3) or more years experience in acute care case management, concurrent review, discharge planning, utilization management or behavioral health for the role of Nurse Medical Management. In this role you will serve on a team of six Utilization Review RNs serving a 100% Medicaid population. You will be responsible for evaluating the necessity, appropriateness, and efficiency of the use of medical services procedures and facilities. You will be responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. You will review, on average, 18 cases per day. You will serve as a patient advocate, seeking and coordinating creative solutions to patients' health care needs without compromising quality outcomes.

Benefits of working in this capacity as opposed to working in a hospital:
- Monday through Friday schedule
- 40 hour work week
- No double shifts
- No weekend hours
- Higher salaries and bonus opportunity

Candidates must be a graduate of an accredited school of nursing and be licensed as an RN in the state of Kansas. Preference given to candidates with a BSN. Must have at least two (2) years of utilization management or hospital/acute care experience. Strong preference given to candidates who have three (3) or more years experience in case management, discharge planning, and utilization management. Strong preference given to candidates with InterQual training.

Competitive compensation and full benefits. This is an excellent opportunity to join a company that is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. It is also a great opportunity for someone looking to get out of an acute care setting into another type of work environment. For more information call 941.739.1400 or submit your resume now by sending to resume@EdgeRecruitmentSolutions.com.
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