Telephonic Utilization Management Nurse vacancy at Keystone Mercy Health Plan in Philadelphia

Keystone Mercy Health Plan is hiring Telephonic Utilization Management Nurse on Fri, 29 Mar 2013 19:37:23 GMT. The Telephonic Utilization Management Nurse is responsible for completing medical necessity reviews using KMHP policies and procedures, reviewing inpatient and outpatient elective procedures requiring prior authorization, inpatient hospital stays, and requesting, assessing and appropriately channeling/facilitating discharge planning requests. Responsible for applying medical health benefit policy...

Telephonic Utilization Management Nurse

Location: Philadelphia Pennsylvania

Description: Keystone Mercy Health Plan is hiring Telephonic Utilization Management Nurse right now, this vacancy will be placed in Pennsylvania. Detailed specification about this vacancy opportunity please read the description below. The Telephonic Utilization Management Nurse is responsible for completing medical necessity reviews using KMHP policies and procedures, reviewing inpat! ient and outpatient elective procedures requiring prior authorization, inpatient hospital stays, and requesting, assessing and appropriately channeling/facilitating discharge planning requests. Responsible for applying medical health benefit policy and medical management guidelines to authorize services. Identifies and refers requests for services to the appropriate Medical Director when guidelines are not met.

JOB REQUIREMENTS:

• Licensed and active Pennsylvania RN license
• Minimum of 3 to 5 years strong utilization review experience in a hospital setting, for a third party payer or other review agency or organization and is comfortable performing chart reviews
• Minimum 2 years Case Management experience.
• Experience using Interqual and/or Milliman criteria
• Ability to type and use a computer required.
• Strong customer service skills with the ability to work under pressure and multitask

WE OFF! ER:

• Competitive salary
• Comprehensive! benefits
• Standard working hours

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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Keystone Mercy Health Plan.

If you interested on this vacancy just click on the Apply button, you will be redirected to the official website

This vacancy starts available on: Fri, 29 Mar 2013 19:37:23 GMT

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