Role OverviewThis position is responsible for performing utilization management (UM) reviews and authorization activities for post-acute services, including Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), Long-Term Acute Care Hospitals (LTACH), Home Health, and other post-acute levels of care.
What You Will Do
The UM Nurse Consultant evaluates medical necessity and appropriateness of services utilizing clinical criteria, applicable policies, and regulatory requirements to support quality, cost-effective care.
Why It Might Be a Fit
This role requires independent clinical judgment, strong critical thinking skills, and the ability to manage multiple priorities in a fast-paced environment.
Requirements
- Active, unrestricted Registered Nurse (RN) license in the state of residence
- Ability to obtain and maintain additional state licensure as required by business needs
- 3+ years of clinical nursing experience
- 1+ years of utilization management, case management, discharge planning, managed care, or post-acute care experience
- Experience reviewing medical records and applying evidence-based clinical criteria to determine medical necessity
- Knowledge of post-acute levels of care, including Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), Long-Term Acute Care Hospitals (LTACH), and Home Health services
- Experience using MCG or similar clinical decision support tools
- Strong clinical assessment and critical thinking skills
- Effective written and verbal communication skills
- Proficiency with electronic medical records and utilization management platforms
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources
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