Utilization Review Nurse | Burr Ridge, Illinois | $33-$40 Per Hour

Company: TotalMed
Location: Orland Park
Posted on: July 10, 2021

Job Description:

Pay: $33-40 per hour

Hours: M-F 8am-5pm

Qualifications: 

• Registered Nurse licensure in Illinois
• Minimum of 1 year of Prior Authorization or Utilization Management experience

Position Purpose:

The purpose of the prior authorization nurse is to provide timely review of authorization requests and ensure the requests meet national standards and contractual requirements. The prior authorization nurses will also promote the quality and cost effectiveness of patient care using clinical acumen. Additionally, the nurses will prepare documentation, perform audits of patient records, and assist management as needed.

Responsibilities

• – Perform clinical reviews of authorization requests using appropriate criteria
• – Provide accurate and complete documentation with rationale used to approve request
• – Collaborate with various staff within provider networks and case management team coordinate patient care
• – Equip and train prior authorization tech with needed resources
• – Ability to multitask between computer and multi-line phone requests
• – Participate in interdepartmental projects when needed
• – Enter and maintain clinical information in multiple health management systems
• – Following guidelines and policies, and approve services or forward requests to the appropriate – Physician or Medical Director with recommendations for other determinations
• – Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings information in various medical management systems

Benefits: 

Keywords: TotalMed, Orland Park , Utilization Review Nurse | Burr Ridge, Illinois | $33-$40 Per Hour, Other , Orland Park, Illinois