Clinical Utilization Management Nurse Reviewer
Location: Minnetonka Minnesota
Description: Humera is currently interviewing Clinical Utilization Management Nurse Reviewer right now, this occupation will be placed in Minnesota. For detail informations about this occupation opportunity please read the description below. Humera, formerly Dolphin Staffing, is seeking a Clinical Utilization Management Nurse Reviewer for a medical insurance provider located in Min! netonka. This is a short term contracted position.
The Clinical Review Manager works within the framework of multiple products to establish collaborative processes that promote quality and cost effective care. This includes identification, assessment, planning, implementation/facilitation, coordination and evaluation of health related service options. These activities require interfacing with members, providers, clinics, medical directors, intake staff, case managers and other departments. Performance is primarily measured by various quality audits, meeting regulatory requirements including but not limited to turn around times, documentation standards, desired interventions impacted, volume of events/cases managed, and ad hoc feedback from members and providers.
Desired Skill Sets
Professional RN or LPN license in MN required
Certified Case Manager (CCM) preferred
BSN or BS/BA preferred with a minimum of three years clinical experience or ! licensed professional with five years clinical experience
! Managed care experience preferred
Previous case management or utilization management experience and a broad base of clinical/hospital experience
General working knowledge of how various health care services link together (the health care continuum)
Experience working with multiple age groups, medical, surgical background and a generalized level of understanding across specialty care areas
Strong customer service skills, strong decision making skills, active, listening skills, patience, independence and excellent organizational skills
Ability to think creatively, negotiate and access resources
Excellent verbal and written skills
Basic PC use and basic typing skills
Ability to work independently
Highly organized, time management skills, requires ability to make decisions under stress and manage multiple complex issues on a daily basis
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If you were eligible to this occupation, please email us your resume, with salary requirem! ents and a resume to Humera.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Thu, 12 Sep 2013 08:06:10 GMT