Utilization Management RN

Company: The Judge Group ( Learn More )

General Information
US-DE-Wilmington
N/A
Not Specified
Full-Time
At least 2 year(s)
Not Specified
False
False
Job Description Judge Healthcare is actively seeking 4 Utilization Management RN's for one of our top clients. This position is on site, office based, located in Wilmington, DE.
This job will have the following responsibilities:
  • implementation of effective utilization management strategies
  • review of appropriateness of health care services
  • application of criteria to assure appropriate resource utilization
  • identification of opportunities for referral to a Health Coach/case management
  • identification and resolution of quality issues. 
  • Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction.

  • Qualifications & Requirements:
  • Current RN license (any state) REQUIRED
  • 2+ years' experience in clinical setting REQUIRED
  • Utilization Management experience REQUIRED
  • Proficiency InterQual experience REQUIRED
  • Two (2) years of any combination of clinical, case management and/or disease/condition management, provider operations and/or health insurance experience REQUIRED 
  • IF INTERESTED AND QUALIFIED, TAKE ACTION NOW AND APPLY!!!!

    Please send your MOST UP TO DATE resume to Johann at [Click Here to Email Your Resumé] or give Johann a call at (484) 270-1842.

    Thank you so much!!

    Johann Evans

    Job Requirements