**Please note: This position is with Nova, a division of Independent Health Corporation (a subsidiary of Independent Health).**
The Utilization Review Nurse performs clinical reviews to determine the medical necessity of requested services. The URN obtains clinical information and utilizes IHA policy and/or defined criteria to determine medical necessity, as if necessary, will consult with the Associate Medical Director for all requests that do not meet criteria or IHA policy.
Active, unrestricted, and licensed registered nurse required. Associates degree in health related field; BSN preferred.
Three (3) years of clinical experience in acute hospital care and/or three (3) years of utilization review experience required.
Previous experience in managed care preferred.
Clinical knowledge of the health or social work needs for the population served.
Demonstrated ability to identify barriers to a successful care management path.
Demonstrated ability to interact effectively with physicians and other members of the health care system.
Proficient PC and Windows skills required, inlcuding MS Office.
Excellent problem-solving abilities and time management skills.
Excellent written, verbal and interpersonal communication skills.
Demonstrated transferable knowledge, skill and ability to complete job duties independently and proficiently. Flexibility in work schedules and assignments.
Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.
Other duties as needed. Every associate is given a job description upon hire outlining the qualifications, duties, and pay grade of the position. Independent Health reserves the right to change job descriptions as necessary.
Independent Health is an equal opportunity employer.
Independent Health - 14 months ago