Utilization Management Nurse-1

Medical University of South Carolina

2d • Onsite

About The Position

MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina (MUSC) that provides healthcare to patients within the rural health network throughout the state of South Carolina. This role involves conducting utilization reviews to determine if patients are receiving care appropriate to their illness or condition, monitoring patient charts and records to evaluate care concurrent with treatment, and reviewing treatment plans and insurer approvals. The position also requires collecting and complying with data according to policies and regulations, and consulting with physicians as needed.

Requirements

• Bachelor's degree in Nursing from an accredited school of nursing
• Three years’ work experience as a Registered Nurse
• 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.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level