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Utilization Review Nurse - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Nashville, Tennessee |
About this job
Actively looking to hire multiple LPNs with inpatient utilization review experience to join a growing 3rd party provider on a Monday - Friday basis with weekends on a rotating basis. Must have experience using Interqual/ Milliman ! This is an URGENT need and will move quick!
Duties:
- Telephonic position responsible for recommending discharge plans, assisting with transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned and non-assigned post-acute care facilities
- Interact with the Medical Director as needed to ensure proper medical necessity decisions are being rendered.
- Partner closely with the Medical Director in care planning and goal setting, reviewing discharge plans and length of stay status to ensure optimal outcomes.
- Authorize continued stay at SNF, IRF, LTACH and Home Health care (if delegated) using approved medical care guidelines and collaboration with key facility personnel within the healthcare setting.
- Use clinical expertise, review clinical information and clinical criteria to determine if the service/device meets medical necessity for the member.
Qualifications:
• You hold a current and unrestricted license as a Licensed Practical Nurse or Registered Nurse.
• You Have obtained an Associate's Degree or Diploma in Nursing/Practical Nursing or the equivalent
• You Have a minimum of 2 years clinical experience in a clinical setting
• You can bring expertise in Utilization Management and knowledge of URAC & NCQA standards.
• You have a MCG/Milliman, Interqual experience .
About Aerotek:
We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.