Case Management / Utilization Review Nurse
$76,000 - $90,000/Yr
Jai Medical Systems Managed Care Organization - Cockeysville, MD
posted about 2 months ago
Full-time - Entry Level
Onsite - Cockeysville, MD
Ambulatory Health Care Services
About the position
The Case Management/Utilization Review Nurse position at Jai Medical Systems Managed Care Organization, Inc. involves providing high-quality healthcare services through case management and utilization review. The role requires a licensed registered nurse to perform telephonic reviews and manage complex cases, ensuring compliance and coordination of care for enrollees. The position is full-time, with a focus on monitoring service quality and effectiveness across the healthcare continuum.
Responsibilities
- Perform telephonic reviews for enrollees across the service continuum (pre-certification/authorization, concurrent and retrospective reviews) utilizing InterQual criteria.
- Monitor providers to ensure the quality, quantity, timeliness, and effectiveness of service.
- Conduct case management/complex case management on identified members to increase compliance and assist with care coordination.
Requirements
- Current valid Registered Nurse license in the state of Maryland.
- Bachelor's degree, preferred.
- Minimum of 2 years' experience as an RN, with at least one year in a hospital setting.
- InterQual experience preferred.
- CPR certified.
- Proficient in Microsoft Office.
- Strong organizational and communication skills.
- Ability to prioritize and manage multiple priorities.
- Strong work ethic and ability to be flexible.
- Independent worker, but able to work well in a team.
- Ability to type a minimum of 35 WPM, preferred.
Benefits
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Free parking
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
