Utilization Management Nurse, Senior- Medicare Concurrent Review
About The Position
The Utilization Management Concurrent Review team reviews the inpatient stays for our members and correctly applies guidelines for nationally recognized levels of care. The Utilization Management Concurrent Review Nurse will report to the Utilization Management Nurse Manager. In this role you will perform first level determination for authorization requests received for members using BSC evidence-based guidelines, policies, and nationally recognized criteria across specific lines of business such as Medicare, Medical, or Commercial plans. You will conduct reviews for authorization requests based on medical necessity and clinical judgment. Detailed knowledge of the benefit plans is necessary to complete review decisions. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Requirements
- Detailed knowledge of the benefit plans is necessary to complete review decisions
Responsibilities
- Perform first level determination for authorization requests received for members using BSC evidence-based guidelines, policies, and nationally recognized criteria across specific lines of business such as Medicare, Medical, or Commercial plans
- Conduct reviews for authorization requests based on medical necessity and clinical judgment
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What This Job Offers
Career Level
Senior
Education Level
No Education Listed
Number of Employees
1-10 employees
