Utilization Management Behavioral Health
Medical University of South Carolina•Remote- South Carolina, SC
•Onsite
About The Position
Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with physicians as needed.
Requirements
- Bachelor's degree in Nursing from an accredited school of nursing and three years’ work experience as a Registered Nurse required.
- Must possess excellent verbal and written communication skills.
- Licensure as a registered nurse by the state of South Carolina or compact state required.
Nice To Haves
- Prior leadership experience preferred.
- One year of case management and/or utilization management work experience preferred.
- Familiarity with InterQual or Milliman and Robinson screening criteria desired.
Responsibilities
- Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition.
- Monitors patient charts and records to evaluate care concurrent with the patients treatment.
- Reviews treatment plans and status of approvals from insurers.
- Collects and complies data as required and according to applicable policies and regulations.
- Consults with physicians as needed.
Benefits
- Staff hired prior to July 1, 2013 will be grandfathered in regards to education requirement.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
