Utilization Review RN (6-12 month Contract- Fully Remote) Job at Green Key Resources, Nampa, ID

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  • Green Key Resources
  • Nampa, ID

Job Description

Job Description

Job Description

Contract (6-12 months) Fully Remote 

Valid unrestricted Registered Nursing License

8-5 M-F MST- Must be willing to work MST hours

Experience: 3-5 years’ utilization management, clinical review experience

Education: Associates Degree in Nursing or Bachelors Degree in Nursing

 

  • Make clinical decisions using approved and accepted plan policies and criteria.
  • Determine eligibility and benefit coverage according to member and provider contracts.
  • Identify appropriate members for medical or behavioral health case management.
  • Respond to requests for authorization of medications or inpatient procedures and services.
  • Document and reports potential quality of care or service issues to leadership.
  • Perform peer to peer audits to assist with consistency of application of business workflows.
  • May provide review according to established criteria for procedural authorization.
  • Perform other duties and responsibilities as assigned.
  • High degree verbal and written communication
  • Independent and critical thinking
  • Handle multiple projects simultaneously
  • Work well in a team environment

Job Tags

Contract work,

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