Registered Nurse, Utilization Management Job at Magnificus Corp.
IMMEDIATE OPENING for a full-Registered Nurse (Utilization Management) to support Scott Air Force Base, IL.
Responsibilities and duties but not limited to:
- Assist in the design and implementation of activities to increase hospital staff involvement in and support of an active and coordinated Medical Management program. Work in coordination with Case Management, Disease Management, Referral Management and other members of the healthcare team in order to assure the seamless delivery of care.
- Incorporate utilization review activities using the generally accepted standards and criteria for determining medical necessity, appropriateness, and reasonableness when reviewing the quality, completeness, and adequacy of health care provided to individual patients and patient populations and subsequently with similar patient populations.
- Seek to reduce overutilization of Emergency Department (ED) or high cost medical settings by identifying patients with chronic diseases (e.g., diabetes, asthma, etc.) that have a significant impact on healthcare outcomes and costs.
- Serve as a primary contact person for utilization management in a multiservice environment.
Qualifications:
Possess current certification in one (1) of the following:
- Certified Professional Utilization Review (CPUR) from McKesson Health Solutions
- Certified Professional Utilization Management (CPUM) from McKesson Health Solutions
- Health Care Quality and Management Certification from American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)
- Certified Professional in Healthcare Quality (CPHQ) from Healthcare Quality Certification Board (HQCB)
- Certified Case Manager (CCM) issued by the Commission for Case Manager Certification
- Advanced Certification in Continuity of Care (ACCC) issued by the National Board for Certification in Continuity of Care
- Nurse Case Manager (RN-NCM) issued by the American Nurses Credentialing Center
- Care Manager Certified (CMC) issued by the National Academy of Certified Care Managers
Benefits include:
· Relocation Assistance (if needed)
· Paid Federal Holidays
· Paid Personal Leave Days
· Health & Welfare Reimbursement
· 401(K)
Please submit resume for immediate consideration.
Job Type: Full-time
Pay: From $1.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: One location
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