Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates. We are created and managed by experienced industry professionals in healthcare. Asa leading provider of contract, contract to perm, and direct placement recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.
Utilization Management Nurses will work with members of the health plan to review medical requests and insure that proper care is being utilized.
Perform utilization management, utilization review, and/or concurrent review for the team
Communicates with practitioners and members on cases
Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines
Facilitate acquisition of discharge needs including equipment, home health care, etc. on all patients requiring assistance
Work with appropriate staff to arrange and coordinate transportation into plan-approved facilities from out-of-network facilities as needed
Maintain contact with facilities/providers treating health plan members in order to coordinate care and discharge planning; Collaborate with the appropriate entity to manage and resolve quality assurance/risk management concerns
Thoroughly document all activity in the utilization/case management documentation system.
Current RN or LVN
Current working knowledge of Utilization management, performance improvement and reimbursement issues is preferred. Utilization review, Case Management, appeals, denials, managed care contracting experience preferred.
Requires excellent observation skills, analytical thinking and problem-solving as well as excellent communication skills
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