Utlization Review Services Nurse
Utilization Review Services Nurse I
Job Description
JOB
Summary:
Conducts utilization reviews on the referrals received. Gathers, summarizes and reviews all medical documentation related to the requested services, compares request to applicable medical guidelines and completes review determination, referring to physician for final review as needed.
ESSENTIAL JOB
Responsibilities:
Collects medical information from providers, summarizes and enters information into the nurses notes in utilization review system
Requests additional medical information/documentation from the provider and adjuster as needed
Notifies appropriate parties of decision within the required time frame depending on state jurisdictional requirements
Becomes familiar with proper coding of services and diagnoses
Becomes proficient in the software used in the department
Contributes to the success of the company and its posture toward customer service by understanding and responding to our client's needs
Responsible for knowing and following various state jurisdictional requirements as well as URAC standards as applicable
Responsible for knowing confidentiality policies and procedures and adhering to them
Performs other duties as assigned
Required Skills
SKILLS/ABILITIES:
Must possess good oral and written communication skills; and the ability to work as a member of the Forte review team
Keyboard typing and dialing of telephone require hand dexterity and the repetitive use of finger movement
Due to the nature of the position, sitting in a sustained position for prolonged periods of time is necessary
Vision must be adequate to view the computer screen.
Due to the varied nature of duties, prolonged sitting, frequent walking throughout the work area and standing for long periods of time are required
Hand dexterity is necessary for keyboard and/or telephone usage
Vision must be adequate for reading and viewing computer screen
KNOWLEDGE:
Must possess knowledge of medical terminology, medical records, and appropriate medical coding systems
Must be computer literate
Required Experience
EDUCATION:
BS / BA or Equivalent Work Experience
Must hold a current nursing license with a minimum of a Bachelor of Science in Nursing, Associate Degree in Nursing, Diploma in Nursing, or Licensed Practical Nursing in the state of residence
Experience:
Two or more year's clinical nursing experience in acute care setting with utilization review experience preferred
Job Location
Kansas City, Kansas, United States
Position Type
Full-Time/RegularEstimated Salary: $20 to $28 per hour based on qualifications.
Job Description
JOB
Summary:
Conducts utilization reviews on the referrals received. Gathers, summarizes and reviews all medical documentation related to the requested services, compares request to applicable medical guidelines and completes review determination, referring to physician for final review as needed.
ESSENTIAL JOB
Responsibilities:
Collects medical information from providers, summarizes and enters information into the nurses notes in utilization review system
Requests additional medical information/documentation from the provider and adjuster as needed
Notifies appropriate parties of decision within the required time frame depending on state jurisdictional requirements
Becomes familiar with proper coding of services and diagnoses
Becomes proficient in the software used in the department
Contributes to the success of the company and its posture toward customer service by understanding and responding to our client's needs
Responsible for knowing and following various state jurisdictional requirements as well as URAC standards as applicable
Responsible for knowing confidentiality policies and procedures and adhering to them
Performs other duties as assigned
Required Skills
SKILLS/ABILITIES:
Must possess good oral and written communication skills; and the ability to work as a member of the Forte review team
Keyboard typing and dialing of telephone require hand dexterity and the repetitive use of finger movement
Due to the nature of the position, sitting in a sustained position for prolonged periods of time is necessary
Vision must be adequate to view the computer screen.
Due to the varied nature of duties, prolonged sitting, frequent walking throughout the work area and standing for long periods of time are required
Hand dexterity is necessary for keyboard and/or telephone usage
Vision must be adequate for reading and viewing computer screen
KNOWLEDGE:
Must possess knowledge of medical terminology, medical records, and appropriate medical coding systems
Must be computer literate
Required Experience
EDUCATION:
BS / BA or Equivalent Work Experience
Must hold a current nursing license with a minimum of a Bachelor of Science in Nursing, Associate Degree in Nursing, Diploma in Nursing, or Licensed Practical Nursing in the state of residence
Experience:
Two or more year's clinical nursing experience in acute care setting with utilization review experience preferred
Job Location
Kansas City, Kansas, United States
Position Type
Full-Time/RegularEstimated Salary: $20 to $28 per hour based on qualifications.
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