Registered Nurse II in Brentwood, TN at Integrated Resources, Inc

Date Posted: 9/23/2022

Job Snapshot

  • Employee Type:
  • Location:
    Brentwood, TN
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Do not submit candidates previously rejected on Req #16039032

5 RN
Performs utilization review activities for Post Acute Care/Home Health & DME requests and contacts providers where additional information is necessary to make a decision
Utilizes decision-making and critical thinking skills in the review and determination of
coverage for medically necessary services using CMS and / or MCG guidelines or
other indicated evidence based guidelines
Review requests not meeting evidence based guidelines with the Medical Director
Sends appropriate system-generated and self-modified letters to providers, member,
claim payer, etc as required and within established timeframes
Identifies members in post-acute care facilities with high risk of readmission and tracks
patient progress
Works collaboratively with case management onsite/remote staff and other departments
as required
Demonstrates knowledge and understanding of cultural competency and complies with
privacy policies and practices
Performs other assignments to meet organizational needs within the professional Product
Provides optimal customer service ensuring positive customer interaction
Documents appropriate clinical information into the preauthorization system
Adheres to productivity, quality, telephonic, and other service standard metrics
Participates in on-going training programs to ensure quality performance and compliance
with guidelines

Current unrestricted Registered Nurse
licensure and ability to obtain in other states
o Certified Case Manager (CCM) desired, but not required
Minimum 5 years clinical experience
o 2 4 years experience in utilization and case management required.
o Post-Acute Facility experience desired
o Medicare/Medicaid managed care program experience preferred

English( Speak, Read, Write )

Certifications & Licenses:
Registered Nurse

Intermediate computer literacy skills with ability to use and troubleshoot
Microsoft Word, Excel, Outlook, and PowerPoint required
o Experience using videoconferencing systems such as WebEx
Position is a remote position
Position is full-time during core business hours with the ability to work any shift
between 7am and 6pm CT, plus potential of on call responsibility after business hours
Ability to sit at a desk 90% of the time and utilize the computer, telephone, and other
office equipment, throughout the entire work day
Dependable and reliable work schedule is essential

Minimum Degree Required: Associate's Degree (Community College, MBO)

City: Brentwood

Start Date: 09/19/2022
End Date: 12/31/2022
Schedule Notes: WAH timezone ; does not matter ; 8am 5pm Monday Friday and some weekends (local time) 40 hours per week with potential OT; some weekends after hours RN Only
Hours Per Week: 40.00
Hours Per Day: 8.00
Days Per Week: 5.00