Utilization Review Operations Nurse

UniMed Direct is a URAC accredited company.  Our full service platform includes prospective, concurrent and retrospective review, peer review and software solutions.

At UniMed Direct, our AIM is:

• A … Aspire to learn, grow, and please those we serve

• I … Invest in people, customers, and employees

• M …Master the quality of products and processes for each of our services

We have an immediate opening for a full-time Operations Nurse and an opportunity to truly make a difference while advancing your career.

Role and Key Responsibilities/Essential Functions:

• Performs utilization review activities according to UR policy and procedures. 

• Contacts providers as appropriate to obtain necessary information.

• Evaluates and authorizes medical necessity of inpatient and outpatient services using approved criteria.

• Refers cases to the Medical Director/Physician Advisor as appropriate.

• Evaluates each case for quality of care

• Documents quality issues and appropriately refers cases to the quality management coordinator.

• Reviews selected requests for quality and follow-up as necessary with the Medical Director.

• Participates in educating providers regarding UR services, policies and procedures.

• Maintains strong working relations with internal and external customers

• Effectively articulates clinical and non-clinical information to personnel of all levels of understanding.

• Communicates information accurately and timely to internal and external staff both orally and in writing. 

Professional Competencies/Educational Requirements/Required Qualifications:

• Active and unrestricted Registered Nurse license

• Clinical experience with a background in acute, sub-acute, inpatient, outpatient or long-term care

• A minimum of 2-3 years clinical experience

• Knowledge of ICD-9 and CPT coding guidelines preferred

• Familiarity with ACOEM or ODG guidelines a plus

• Self-directed, excellent work ethic, and a strong sense of leadership

• PC proficiency

Embrace the UniMed culture, FISH! Philosophy, and our AIM

UniMed Direct offers a full range of comprehensive benefits, including medical and dental, life and a wide host of ancillary benefits, as well as a 401k plan. If you are interested in growing professionally within an innovative, highly respected organization, we invite you to explore this excellent growth opportunity!  We believe diversity creates a healthier atmosphere-apply to see why!

Please fax your resume and cover letter to 972-931-5125 or email them to resumes@unimeddirect.com.

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