What are the responsibilities and job description for the Utilization Review Nurse position at w3r Consulting?
Job Title: Nurse Case Management Senior Analyst
Location: TN (Remote in TX, IL, NM, OK or TN)
Contract duration: 6 months (Contract to hire)
Schedule: 8am to 5pm (M-F)
Description:
- Delivers specific delegated tasks assigned by a supervisor within the Nurse Case Management job family.
- Plans, implements, and evaluates appropriate health care services in alignment with the physician’s treatment plan.
- Utilizes strong clinical skills to assess, plan, implement, coordinate, monitor, and evaluate care options and services to support optimal healthcare outcomes for members.
- Ensures case management program objectives are met by reviewing the effectiveness of alternative care services while maintaining cost-effective, high-quality care.
- Provides clinical assessments, health education, and utilization management support to members.
- Conducts prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
- Independently manages a personal caseload and coordinates all assigned cases.
- Completes daily Nurse Case Management responsibilities without immediate supervision, while having access to guidance from senior team members when needed.
- Anticipates needs and issues through forward planning; resolves non-routine matters escalated from junior staff.
Required Qualification:
- Active, unrestricted Registered Nurse (RN) license is required.