Utilization Review RN

Job Description

Job Description

Description :

Nurses – are you looking for a change? Want to work no nights, no weekends, and no holidays? Be able to work from home 50% of the time once trained? Check out Hines & Associates!

ABOUT US :

Hines is a nationwide, independent leader in personalized managed health care, focused on what’s important to you—comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.’s reputation as an industry leader is founded on over three decades of innovative and professional health care excellence. Serving all aspects of the industry, Hines is committed to conserving health care dollars while ensuring quality care through effective programs and personalized service.

WHAT WE OFFER :

• Competitive salary and benefits, including medical, dental, vision, long-term care, short-term disability, long-term disability, company paid and voluntary life insurance. Critical Illness, accident insurance and flexible spending also available!
• 401k plan with company match, fully vested after 1 year.
• No weekends and nights!
• Paid Holidays
• Work-life balance.
• Remote / hybrid setting (once trained)

ROLE DESCRIPTION :

This individual will utilize clinical knowledge and communication skills to obtain patient specific information regarding patient condition and proposed treatments and procedures to determine if illness and / or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement. This individual will certify treatment for confinement when criteria and / or practice guidelines are met, in accordance with the health benefit plan, disability, workers compensation regulations and state and federal regulations. If these conditions do not appear to be met, this individual will defer decision to a second level reviewer. This individual interfaces with case managers and disease management nurses on active cases involved in other Hines’ programs.

RESPONSIBILITIES AND PERFORMANCE :

COMMUNICATION :

PERSONAL AND PROFESSIONAL :

PM21

Requirements : QUALIFICATIONS :

Compensation details : 57244-62180 Yearly Salary

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