Home_Health

RN Utilization Review

Milwaukee, WI 53211
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Requirements
Great Full Time Opportunity! Great Benefit Package! Maxim Healthcare has a new opportunity for Registered Nurses that are interested in providing utilization review of insurance claims to determine medical necessity.

*Full Time hours
*Minimum of 1 year experience
*Insurance Utilization Review and appeals/denials experience in most recent work history.
*Medical determinations if claim meets the benefit coverage requirements.
*Current WI RN License

For immediate consideration please contact Heather Dickman, Regional Recruiter at 443-860-5575 or email your resume directly to hedickma@maxhealth.com. I look forward to speaking with you!

Responsibilities include:
• Perform and coordinate the initial assessments and ongoing reassessments of the patient’s status.
• Document patient case information within a database system.
• Perform chart review/audits monthly or as needed.
• Participate in monthly case conferences by providing information pertinent to patient’s needs/goals.
• Partner with the Program Director in development and review of the patient’s individualized coordination of care plan.
• Ensure that the patient's medical needs are addressed; consult with the patients physicians as needed, coordinating plans of treatment, and advocating for the patient when necessary.
• Promote understanding of the medical factors affecting the targeted population.
• Identify and assist patient in accessing entitlements, resources, information, and referrals for psychosocial needs.
• Participate in Quality Assurance and Utilization review activities, as directed.
• Empower patients in decision making for care planning.
• Maintain accurate and timely patient information, which readily accessible for review and meet all requirements; assist in data collection for reporting/funding sources.
• Foster intra-facility and inter-facility working relationships to help accomplish goals. Act as a liaison between primary care providers, specialist, and/or patient.
• Advocate on behalf of patient regarding accessibility of services.
• Follow State/Country mandated guidelines for the nurse case management programs.
• Participate in outreach activities to the entire target population, as directed.
• Recommend program/service changes to meet gaps in service in the community.
• Other duties as assigned

Qualifications include:
• Minimum RN with Bachelors in Nursing, Master in Nursing or Public Health preferred.
• Current RN License.
• Prefer at least one year of Case Management experience.
• Current BLS card per contract requirements.
• Current physical exam per state or contract requirements.
• Full command, verbal and written, of the English language.
• Must pass all Maxim screening exams with 80% or greater.
• Must pass criminal background screening.
• Current TB or Chest x-ray.

Maxim employees are our greatest asset. We offer the following benefits:
• Medical, Dental, Vision, and Life Insurance
• 401k Program
• Competitive Pay
• Flexible Scheduling
• Direct Deposit
• Positive Work Environment and Internal Bonuses
• Travel Benefits (as applicable)
• 24 hour on- call service

Since 1988, Maxim Healthcare Services has become one of the largest employers of clinicians in the nation. At Maxim Staffing Solutions, a division of Maxim Healthcare Services, we’re known for our quality of patient care, commitment to employee development and emphasis on customer service. Maxim knows that you deserve great benefits, flexible scheduling and rewarding assignments, so our Healthcare Recruiters will match your skills, experience and schedule in order to find you the best assignments in top medical facilities. Maxim Recruiters are always available to provide you with the assistance you need to get your job done, so call us today; Maxim has a solution for you.

EOE/AAE

Compensation and Benefits
$0.00 - $0.00 / hour
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