Utilization Management Nurse-1

Medical University of South Carolina

2d

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 conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition.

Requirements

• Bachelor's degree in Nursing from an accredited school of nursing
• Three years’ work experience as a Registered Nurse
• Licensure as a registered nurse by the state of South Carolina or compact state required.
• Excellent verbal and written communication skills.

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

• Health, dental, vision, and life insurance
• Employer Sponsored Retirement Plan
• Paid time off and extended sick leave
• Paid Parental Leave
• Disability insurance plan options
• Continuous professional and clinical training
• Competitive pay
• Annual Merit Increase
• Wellbeing resources
• Tuition Reimbursement
• Employee perks and discounts
• Employee referral program
• Flexible schedule options
• Certification incentive program

What This Job Offers

• Career Level: Mid Level