Job Description
Job Title: Utilization Management NurseJob Description
As a Utilization Management Nurse - Post Acute, you will be responsible for reviewing and documenting prior authorization and concurrent stay requests, as well as member case histories, in compliance with policies, procedures, clinical criteria (MCG), and member coverage. This role requires remote interfacing with members, providers, facilities, medical directors, intake staff, case managers, and other departments internally. Attention to detail and clinical judgment are essential to determine the medical necessity of post-acute stays, including skilled nursing facilities, acute inpatient rehabilitation, and long-term acute care.
Responsibilities
+ Review and document prior authorization and concurrent stay requests.
+ Evaluate member case history in compliance with policies and procedures, clinical criteria (MCG), and member coverage.
+ Interface remotely with members, providers, facilities, medica...
As a Utilization Management Nurse - Post Acute, you will be responsible for reviewing and documenting prior authorization and concurrent stay requests, as well as member case histories, in compliance with policies, procedures, clinical criteria (MCG), and member coverage. This role requires remote interfacing with members, providers, facilities, medical directors, intake staff, case managers, and other departments internally. Attention to detail and clinical judgment are essential to determine the medical necessity of post-acute stays, including skilled nursing facilities, acute inpatient rehabilitation, and long-term acute care.
Responsibilities
+ Review and document prior authorization and concurrent stay requests.
+ Evaluate member case history in compliance with policies and procedures, clinical criteria (MCG), and member coverage.
+ Interface remotely with members, providers, facilities, medica...
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