RN Utilization Management

Location: Eagan, MN
Great opportunity for a RN Utilization Management in Eagan, Minnesota.

Responsibilities of the RN Utilization Management:
  • Conduct investigations and reviews of member and provider grievances and appeals.
  • Review prospective, inpatient, or retrospective medical records of denied services for medical necessity. 
  • Extrapolate and summarize medical information for medical director, consultants and other external review. 
  • Prepare recommendations to either uphold or deny appeal and forwards to Medical Director for approval. 
  • Ensure that appeals and grievances are resolved timely to meet regulatory time frames. 
  • Document and log appeal/grievance information on relevant tracking systems and mainframe systems. 
  • Generate appropriate written correspondence to providers, members, and regulatory entities. 
  • Serve as technical resource to team and may be assigned to work on projects impacting development, interpretation, and implementation of medical policy or other managed care initiatives. 
Requirements of the RN Utilization Management:
  • Requires 2-4 years or more of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background.
  • Current active unrestricted RN license to practice as a health professional within the scope of licensure in the state of Minnesota required.
  • Appeals experience highly desired.
  • Utilization Management experience highly desired.
  • Medicaid experience preferred.
  • Managed Care experience preferred.
  • Critical Care (ER/ICU) experience very helpful.
  • Minimum of 5 years of direct-care experience strongly preferred.
 
Regards,
 
Stacey Soilis
Full Cycle Healthcare Recruiter
Healthcare Employment Partners
Direct Line:
561 409-5777
Toll free: 855 423-7633
 ext. 200
Fax: 855 423-7634
stacey@hcepartners.com
www.hcepartners.com
   

   

 
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