- \n
- Conduct assessments of medical services to ensure they meet medical necessity criteria, such as CMS, Milliman Care Guidelines, or InterQual.<\/li>\n
- Examine patient records to verify the quality and necessity of services.<\/li>\n
- Provide clinical expertise and guidance to non-clinical staff members.<\/li>\n
- Manage essential clinical information on medical management platforms.<\/li>\n
- Stay updated on regulatory requirements and ensure adherence to state standards for utilization review.<\/li>\n
- Collaborate with physicians, management teams, and the Medical Director to ensure high-quality patient care.<\/li>\n
- Oversee quality issue reports and work on continuous improvement of the review process.<\/li>\n<\/ul>\n
Requirements<\/strong><\/h3>\n
- \n
- Licensing: A current, unrestricted LVN or RN license from an accredited program is required.<\/li>\n
- Experience: At least 2 years of clinical nursing experience and 1 year of Utilization Management experience.<\/li>\n
- Proficiency in Microsoft tools (Word, Excel, PowerPoint, Outlook).<\/li>\n
- Strong written and spoken communication skills, organizational abilities, and attention to detail.<\/li>\n
- Work Environment: Ability to work from home with an uninterrupted internet connection, maintaining a comfortable home office setup.<\/li>\n<\/ul>\n
Additional Details<\/strong><\/h3>\n
- \n
- PRN\/On-Call Position: Flexible staffing to support the team during peak times, requiring availability for weekends and holidays.<\/li>\n
- Education\/Training: Ongoing professional development and skills acquisition to adapt to evolving tools and systems.<\/li>\n
- Benefits: Comprehensive health coverage, paid time off, 401k with company match, life insurance, disability coverage, and more.<\/li>\n<\/ul>\n
Compensation<\/strong><\/h3>\n
- \n
- Starting compensation will be based on experience, education, and skills, with opportunities for bonuses and other incentives.<\/li>\n<\/ul>\n
About Dane Street<\/strong><\/h3>\n
Dane Street is a high-performance company, processing over 200,000 insurance claims annually for major national and regional health carriers and other industry partners. The company is committed to diversity, inclusion, and competitive compensation.<\/p>\n
If you’re interested, applying for the role could provide a valuable opportunity to leverage your clinical expertise in an impactful, flexible position with competitive benefits.<\/p>\n
PRN Utilization Review Nurse Reviewer – LPN -id-5249<\/h4>\n
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- Starting compensation will be based on experience, education, and skills, with opportunities for bonuses and other incentives.<\/li>\n<\/ul>\n