1 Utilization Review Nurse Job in Leonia, NJ
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LanceSoft Inc is Hiring an Utilization Review Nurse Near Leonia, NJ
- Performs utilization management reviews in accordance with federal and state regulations
- Maintains compliance with regulatory changes affecting utilization management
- Perform UM reviews (prospective/concurrent/retrospective) for inpatient services according to the NCQA, URAC, CMA & DOH standards and client requirements and/or policies
- Reviews UM requests for services against established clinical review criteria, referring cases not meeting criteria to a physician reviewer
- Adheres to Department of Labor, state and UM timeframe requirements per contract
- Coordinates physician reviewer referral as needed and follows up timely to obtain and deliver those results
- Tracks status of all utilization management reviews in progress
- Releases UM determinations to claim stakeholders following client-established protocols
- Works closely with management team in the ongoing development and implementation of utilization management programs
- Certifies reviews that meet clinical review criteria/guidelines
- Adheres to quality standards and UM guidelines
- Maintains all required utilization management review documentation in the UM software in a timely manner
- Refer cases to case management as indicated/appropriate
- Responds to inbound telephone calls pertaining to UM reviews in a timely manner, following client-established proto
- Maintains confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols
- Maintains acceptable levels of performance including but not limited to attendance, adherence to protocols, customer courtesy, and all other productivity and efficiency targets and objectives
- Learns new methods and services as the job requires
Diversity, Equality, and Inclusivity This means a deep commitment to each other equally, in an open, diversified team environment. We strive to be as diverse as the clients and employees we partner with. We embrace people of any race, ethnicity, national origin, religion, gender identity, and sexual orientation. LanceSoft is a certified Minority Business Enterprise (MBE).
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Job Summary
Contractor
Business Services
$92k-114k (estimate)
05/18/2024
05/24/2024
lancesoft.com
HERNDON, VA
500 - 1,000
2000
Private
DIVYA GANDHI
$200M - $500M
Business Services
Related Companies
About LanceSoft Inc
LanceSoft is a provider of application development, management outsourcing and data-warehousing services to the aerospace and automotive sectors.
The job skills required for Utilization Review Nurse include Accountability, Confidentiality, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Review Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Review Nurse. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Review Nurse positions, which can be used as a reference in future career path planning. As an Utilization Review Nurse, it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Nurse. You can explore the career advancement for an Utilization Review Nurse below and select your interested title to get hiring information.
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