What are the responsibilities and job description for the Utilization Management Nurse position at Actalent?
Description:
- Will provide service and support to members and health care providers- including pre-service reviews, out of network referrals and support for Health Plan of Iowa
- Utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical criteria (InterQual) and benefit information
- Provide consultation and responses to utilization management requests
- May complete medical reviews any apply utilization review criteria for patient admissions and various levels of care, continued stay reviews, and/or discharge planning
- All reviews will be done in the component content management system (CCMS- internal database) but could interact directly with providers via email or phone for clinical or urgent denial requests
- Establishes relationships and effectively engages with members and providers through telephonic communication; obtains necessary information and facilitates care in multiple settings
- Responsible for minimum of 25 reviews a day with a 97% QA review. All reviews will be done in their Jiva systems
- Strong written communication skills; accurately documents events within the care management platform. Strong technical acumen; learns new systems quickly - e.g. Microsoft Office, clinical documentation platforms, etc.
Additional Skills & Qualifications:
- Completion of an accredited registered nursing program
- Active and unrestricted RN license in Iowa; individual must be licensed in the state in which they reside. Must have a Compact License if they are not living in Iowa or South Dakota. Will consider LPNs, but RNs are highly preferred.
- 4 years of diverse clinical experience (e.g., critical care, acute care, outpatient) with direct clinical care to the consumer. Acute Care, Home Health and Med Surg experience preferred/ideal. Looking for candidates with a lot of breadth vs depth in one area of focus.
Candidates with prior UM/Prior Authorization experience are encouraged to apply!
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent
- Maintaining an inclusive environment through persistent self-reflection
- Building a culture of care, engagement, and recognition with clear outcomes
- Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Salary : $33 - $38
