Utilization Management Coordinator - Registered Nurse (RN)

Company: HCSC
Location: Albuquerque
Posted on: February 20, 2021

Job Description:

BASIC FUNCTION:
This position is responsible performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and Medical and Network Management Divisions. This position reviews service requests, collects clinical and non-clinical data, verifies eligibility, determines benefit levels in accordance to contract guidelines, prepares reports on quality of care, identifies and reports cases, and provides information regarding utilization management requirements and operational procedures to members, providers and facilities. This position will be engaged with Utilization Management Review.

JOB REQUIREMENTS:
*Registered Nurse (RN) with valid, current, unrestricted license in The State of New Mexico.
*3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.
*Knowledge of medical terminology and procedures.
*Verbal and written communication skills.
*Willingness and ability to travel, on a rare occasion, if needed.

PREFERRED JOB REQUIREMENTS:
* 2+ years of Utilization Management experience is preferred.
* 3 years of clinical experience in various environments including: acute hospital setting, physician office, LTACH/SNF, home health, surgical setting or health care insurance company.
* In-patient nursing experience.
* Specialty RN experience - Oncology, NICU, O/R, Cardio, etc. - a variety of clinical experience is preferred - NOT limited to NICU or Maternal Health
* Intensive Care and/or Critical Care experience is preferred.
* Case Management, Care Management, Condition Management and/or Disease Management experience is a plus.
* MCG Certification is a plus.

*CA

#LI-DP1

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements:
Expertise Nursing Job Type Full-Time Regular Location NM - AlbuquerquePandoLogic. Keywords: Utilization Review Coordinator, Location: Albuquerque, NM - 87131

Keywords: HCSC, Albuquerque , Utilization Management Coordinator - Registered Nurse (RN), Executive , Albuquerque, New Mexico