Utilization Management RN

Job description

Get To Know Us! WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. What is your impact?: Utilization Management (UM) nurses will provide our clients with appropriate and comprehensive utilization of health care services and benefits as designated. This requires an experienced RN with a diverse clinical background, as well as experience within the managed care industry and specifically in the self-funded arena. The UM Nurse will work with providers, hospitals, members and clients to achieve optimal outcomes through appropriate use of services and benefits. - Pre-Certification of emergency, urgent and elective admissions, and the determination of length of stay based on age, multiple or single diagnoses, and the nature of the diagnosis. Medical record review to determine medical necessity of requested services. - Concurrent review and the determination of the extension of the length of stay based on the severity of illness and the intensity of service. Medical record review to determine medical necessity of requested services. - Assist with Discharge Planning...