Massachusetts Licensed UM Nurse Specialist in Baton Rouge, LA
Job Description
A company is looking for a UM Regulatory Nurse Specialist.
Key Responsibilities
Conduct pre-authorization, admission, concurrent, and retrospective reviews to assess the appropriateness of services and care levels
Assist with care coordination, referral management, and proactive discharge planning for members
Develop and coordinate compliance education and training activities, and manage compliance regulatory filings and audits
Required Qualifications
Massachusetts RN license required
3-5 years' experience as a UM Clinical Review Nurse for a Health Plan
Understanding of the use of medical coding
Strong critical thinking and analytical skills
Innovative thinker with strong research skills
Key Responsibilities
Conduct pre-authorization, admission, concurrent, and retrospective reviews to assess the appropriateness of services and care levels
Assist with care coordination, referral management, and proactive discharge planning for members
Develop and coordinate compliance education and training activities, and manage compliance regulatory filings and audits
Required Qualifications
Massachusetts RN license required
3-5 years' experience as a UM Clinical Review Nurse for a Health Plan
Understanding of the use of medical coding
Strong critical thinking and analytical skills
Innovative thinker with strong research skills
Job Details
Medical Speciality
Primary Care
Employment Type
Full-time
Required License
RN (Registered Nurse)
Work Setting
Telehealth
Similar Jobs
Professional Case Management•Ida, LA•3 days ago
Monument Health•Kaplan, LA•4 days ago
Monument Health•Abbeville, LA•4 days ago
Monument Health•Bogalusa, LA•4 days ago
Monument Health•Bridge City, LA•4 days ago
About Virtual Vocations
Virtual Vocations is an online job board that connects job seekers to legitimate remote jobs. Founded in 2007 by Laura Spawn and her brother Adam, the company is driven by a mission to help individuals find remote work quickly and safely. As a 100% virtual company, Virtual Vocations understands the challenges of remote job seekers and provides a human-screened job board with thousands of opportunities across various categories. The family-owned service is committed to supporting remote success and offers resources for job seekers and professionals.