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Job Description: Utilization / Case Management Nurse (RN) Utilization / Case Management Nurse (RN) Location: Tampa, FL Salary:  Experience: 3.0 year(s) Job Type: Temporary / Consulting Job ID: U1007126       About the Opportunity An insurance company in Florida is actively seeking a licensed Registered Nurse (RN), with a strong Utilization and/or Case Management background, for a promising position with their growing staff. In this role, the Utilization / Case Management Nurse (RN) will be responsible to conducting pre-authorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. Company Description Insurance Company Job Description The Utilization / Case Management Nurse (RN): Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review Conducts initial medical necessity review of exception pre-authorization requests for services requested outside of the client health plan network Notifies ordering physician or rendering service provider office of the pre-authorization determination decision Follows-up as necessary to obtain additional clinical information as applicable Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics Required Skills 3+ years of Clinical Nursing experience in an Ambulatory and/or Hospital setting BSN Registered Nurse (RN) license Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and Managed Health Care, including HMO, PO and POS plans Solid assessment and documentation skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Previous Utilization and/or Quality Management and/or Call Center experience

Job Description: Utilization / Case Management Nurse (RN) Utilization / Case Management Nurse (RN) Location: Tampa, FL Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1005862       About the Opportunity An insurance company in Florida is actively seeking a licensed Registered Nurse (RN), with a strong Utilization and/or Case Management background, for a promising position with their growing staff. In this role, the Utilization / Case Management Nurse (RN) will be responsible to conducting pre-authorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. Company Description Insurance Company Job Description The Utilization / Case Management Nurse (RN): Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review Conducts initial medical necessity review of exception pre-authorization requests for services requested outside of the client health plan network Notifies ordering physician or rendering service provider office of the pre-authorization determination decision Follows-up as necessary to obtain additional clinical information as applicable Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics Required Skills 3+ years of Clinical Nursing experience in an Ambulatory and/or Hospital setting BSN Registered Nurse (RN) license Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and Managed Health Care, including HMO, PO and POS plans Solid assessment and documentation skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Previous Utilization and/or Quality Management and/or Call Center experience

Job Description: Utilization Management Licensed Practical Nurse (LPN) Utilization Management Licensed Practical Nurse (LPN) Location: Tampa, FL Salary:  Experience: 3. year(s) Job Type: Temporary / Consulting Job ID: U1014143       About the Opportunity A Florida-based health insurance company is currently seeking an experienced Licensed Practical Nurse (LPN), with a strong Utilization Management background, for a promising position with their growing staff. In this role, the Utilization Management Licensed Practical Nurse (LPN) will be responsible for conducting pre-authorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. Apply today! Company Description Health Insurance Company Job Description The Utilization Management Licensed Practical Nurse (LPN) will be responsible for: Conducting initial medical necessity clinical screening and determining if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review Conducting initial medical necessity review of exception pre-authorization requests for services requested outside of the client health plan network Notifying the Ordering Physician or rendering service provider office of the pre-authorization determination decision Following-up, as necessary, to obtain additional clinical information as applicable Ensuring proper documentation, provider communication, and telephone service per department standards and performance metrics Required Skills 3+ years of Clinical Nursing experience in an Ambulatory and/or Hospital setting Bachelor's Degree in a related field FL Licensed Practical Nurse (LPN) Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and Managed Healthcare, including HMO, PO and POS plans Solid assessment and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Utilization and/or Quality Management and/or Call Center experience

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