A Client Innova Solutions Is Immediately Hiring for
Utilization Management Compliance Nurse.Position Type: Full-Time ContractDuration: 03 MonthsLocation: Pennsylvania As a Utilization Management Compliance Nurse you will:- Assesses regulations and standards (NCQA, CMS and State) and assures appropriate controls are in place, making recommendations and overseeing implementation of new controls where necessary.
- Reports on potential issues and trends monthly impacting efficiency and quality based on compliance audit findings to Managers and Director.
- Performs ongoing sample case reviews to assure that staff are applying InterQual and medical and departmental policy guidelines correctly and referring appropriate cases to the Medical Director. Assures that information provided to the Medical Director is relevant and helpful in making determinations.
- Assures that clinical staff are documenting appropriately in medical management system so that member letters are clear, understandable, and meet regulatory requirements.
- Acts as a resource for internal and external sources, utilizing excellent communication skills and responding in a timely and focused professional manner.
- Other duties as assigned.
The Ideal Candidate will have:- Minimum five (5) years clinical experience.
- Active PA Licensed Registered Nurse required.
- Knowledge of utilization of review processes and utilization management systems, moderate to strong knowledge of InterQual required.
- Excellent verbal and written communication skills with a key focus on attention to detail.
- Experience adhering to NCQA, CMS and other programs requiring regulatory compliance.
- Strong use of Excel, Power Point and Word.
Preferred:- Registered nurse, BSN Preferred.
Qualified candidates should
APPLY NOW for immediate consideration!
This position is only open to applicants who can be engaged on a W-2 basis.Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines.
ASK ME HOW.Thank you!
Pranshi Srivastava
[email protected]PAY RANGE AND BENEFITS:Pay Range*: $40 - $45.12 per hour
*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.
Benefits: Innova Solutions offers benefits (based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).
