Utilization Review Nurse-RN

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Overview

Personify Health is a trailblazer in creating a personalized health platform that integrates health plan administration with holistic well-being solutions and comprehensive care navigation. The company is on a mission to empower individuals to lead healthier lives by offering data-driven solutions that not only reduce costs but also improve health outcomes significantly.

Job Title and Responsibilities

The position available is for a Utilization Review Nurse-RN. This role demands professional assessments and the review of medical necessity concerning treatment requests and plans. The standard work schedule is structured from Monday through Friday, 8:00 AM to 5:00 PM Pacific Time, with rotating weekend coverage as needed.

Key Responsibilities

The responsibilities of the Utilization Review Nurse include:

• Conducting comprehensive assessments to determine the medical necessity of treatment requests.
• Reviewing outpatient services and ancillary pre-certification requests for medical appropriateness.
• Assessing inpatient hospital stays for medical necessity.
• Collaborating with hospital staff to facilitate patient discharges.
• Processing appeals for non-certification and documenting all reviews appropriately.
• Maintaining HIPPA compliance and managing confidentiality effectively.
• Completing all required yearly training and passing annual testing.

The role requires the nurse to meet specific productivity, quality, and turnaround times daily while ensuring compliance with external audits, including URAC and NCQA.

Qualifications

To qualify for the position of Utilization Review Nurse, candidates need to meet the following educational and experiential criteria:

• A current RN license in the United States or U.S. territory.
• An Associate’s degree or diploma from a nursing program is required.
• A minimum of one year of clinical experience in nursing is necessary.

Skills and Abilities

Candidates must be capable of successfully performing the essential functions of the job, with or without accommodation. Key skills and abilities include:

• Strong ability to maintain attendance and manage time effectively.
• Proficiency in operating computers and using office machinery.
• Effective communication skills to relay information accurately, ensuring a clear exchange of ideas and data.
• Attention to detail when observing and reviewing medical documentation.

Work Environment

At Personify Health, the work environment fosters diversity and inclusivity. They value various backgrounds and experiences, believing that this diversity drives innovation and collaboration.

Salary and Benefits

The Utilization Review Nurse position offers a competitive base salary ranging from $30 to $38 per hour, dependent on the candidate’s location, skills, and experience level. Here are some key benefits associated with the role:

• Comprehensive medical and dental coverage effective from day one.
• Paid Time Off, emphasizing the importance of rest and recharge.
• Mental health support and retirement planning options are available.
• Opportunities for professional development with clear career progression paths and associated learning budgets.

Why Work at Personify Health?

Personify Health prides itself on creating a mission-driven culture where diverse perspectives lead to REAL impacts on people's health. They seek to cultivate a workplace that respects and empowers employees from all backgrounds.

Conclusion

The Utilization Review Nurse-RN role at Personify Health is a promising opportunity for qualified nursing professionals. Along with competitive compensation and benefits, the position supports a meaningful mission to improve health outcomes and enhance individual well-being. Candidates interested in this role should prepare for a supportive and innovative work environment that prioritizes both personal health and professional growth.

This job offer was originally published on himalayas.app