Utilization Review Nurse Job at Acara Solutions, Williamsville, NY

Y1E0NGtpTlFVTHVFVEJQRWVtOFBBcXB4U1E9PQ==
  • Acara Solutions
  • Williamsville, NY

Job Description


Acara Solutions is seeking a Utilization Review Nurse to join our client in Williamsville, NY! 

*Must be Licensed in NYS*

Duration: 6 month contract with possible extension

Hourly Rate: $35.00-$38.00/HR

Schedule: Monday-Friday, full-time hours

  • Provide High Quality, Professional Utilization Management Services: (Medical necessity review for prior authorization, pre-certification, concurrent, as well as pre-claim or retrospective payment review.)
  1. Prompt, courteous, professional and error free in performing utilization management functions.
  2. Available to answer inbound phone calls within required timeframes.
  3. Maintain quality of reviews and documentation by demonstrating sound judgment, excellent analytical and communications skills with attention to detail, utilizing designated criteria and/or policy as required.
  4. Complete requests in compliance with designated turnaround time.
  • Maintain Accurate Records:
  1. Clear documentation of clinical information for medical necessity review of all requests, procedures, admissions, and concurrent review.
  2. Accurate documentation of criteria, policy or AMD review in case notes.
  3. Complete and timely follow through for disposition of cases - MD reviews, chart reviews, audits, case management referrals, etc.
  • Provide Technical and Professional Expertise:
  1. Demonstrate accurate understanding of regulatory and contractual issues for all employer/member groups.
  2. Ability to ascertain and gather appropriate information for completion of inquiry (i.e. medical necessity).
  3. Maintain current level of knowledge of nursing, medical and health trend issues.

Job Requirements

Required Skills / Qualifications:

  • Associates Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse (RN) required. 
  • Two (2) years of clinical experience as an RN in a varied clinical setting required. 
  • Previous utilization review or utilization management experience required. 
  • Previous appeal experience in a managed care organization / familiarity with Medicare (CMS) member appeals beneficial. 
  • Experience following established medical guidelines required. 
  • Clinical knowledge of the health or social work needs for the population served. 
  • Demonstrated ability to identify barriers to a successful care management path. 
  • Ability to interact effectively and professionally with internal and external customers 
  • Proficient PC Navigational skills required; solid data entry and MS Office skills required. 

Aleron companies (Acara Solutions, Aleron Shared Resources, Broadleaf Results, Lume Strategies, TalentRise, Viaduct) are Equal Employment Opportunity and Affirmative Action Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity, sexual orientation, national origin, genetic information, sex, age, disability, veteran status, or any other legally protected basis. The Aleron companies welcome and encourage applications from diverse candidates, including people with disabilities. Accommodations are available upon request for applicants taking part in all aspects of the selection process.

Applicants for this position must be legally authorized to work in the United States. This position does not meet the employment requirements for individuals with F-1 OPT STEM work authorization status.

Job Tags

Hourly pay, Full time, Contract work, Temporary work, Monday to Friday,

Similar Jobs

Lensa

Junior Data Analyst - FBI ECS Job at Lensa

 ...Secret/SCI Public Trust/Other Required: None Job Family: Data Analysis Skills Atlassian,Business Analysis,Microsoft...  ...Required Yes Job Description Own your career as a Data Analyst Junior. GDIT is your place to make meaningful contributions to... 

NoeCee Global Inc.

Junior Marketing Associate Job at NoeCee Global Inc.

 ...Join Our Team as an Entry-Level Marketing Associate!No Experience? No Problem. Were Looking for Ambitious, Driven Individuals to Grow with Us! Position Overview:As anEntry-Level Marketing Associate, youll have the opportunity to learn and grow in various aspects of... 

Apple Lincoln Apple Valley

Receptionist P/T Job at Apple Lincoln Apple Valley

 ...location automotive company founded on the belief that people come before profit. Our Vision is to be Famous for Extraordinary Customer Experiences with People who are Empowered to Create Growth and Loyalty for a Lifetime.Apple Autos is seeking a skilled and friendly... 

welocalize

German Transcription Specialist Job at welocalize

 ...Welo Data works with technology companies to provide datasets that are high-quality, ethically sourced, relevant, diverse, and scalable...  ...OVERVIEW We are looking for a highly accurate and detail-oriented German Transcription Specialist to join our team. In this role, you... 

One World Global Services

Russian:Interpreter Moldova Job at One World Global Services

 ...WE ARE HIRING EXPERIENCED INTERPRETERS PER MINUTE!!! LANGUAGE: RUSSIAN Requirements: ~90% English proficiency~ Steady wired internet connection ~ USB Wired headset ~ Windows 10or MacOS WHAT WE OFFER YOU: Fully remote position with a clear schedule...