Concurrent Review Precertification Nurse

A non-profit New York corporation that conducts reviews to evaluate clinical decisions and services rendered by medical practitioners at all levels of the health care continuum is looking for an experienced Concurrent Review Precertification Nurse.

In this position you will:

• Perform utilization review, pre-authorization, and concurrent and retrospective reviews as needed for inpatient or outpatient services and predetermination reviews for services or levels of care 
• Identify and address areas that prolong a patient’s length of stay
• Monitor and evaluate the quality and appropriateness of healthcare provided to members
• Identify high-dollar cases and catastrophic cases and make appropriate referrals to the case management department

Please be advised that we are only considering nurses with the following: 

• Current Nursing License, RN preferred
• Minimum 3 years experience in utilization review
• Minimum 3 years clinical nursing experience in medical/surgical, acute care, or critical care
• Knowledge of different insurance products, such as PPO and EPO
• Computer proficiency with Microsoft Windows, email, and internet
• Experience with customer service

How Pathway Medical Works with You to Get the Job
 
Since 1998 we have focused exclusively on helping nurse case managers and related non-bedside nursing professionals find career opportunities that fit their lifestyle and advance their careers.
 
* We have long-standing relationships with nurse executives at dozens of leading healthcare organizations, ensuring that your accomplishments and skills get noticed by key decision makers.     
 
* We will review your resume to make certain it emphasizes the important skills and experience requirements of the job for which you are applying.
 
* We will then prepare you for your interview, enabling you to show why you are the best candidate for the job.


 
We look forward to receiving your application for the Concurrent Review Precertification Nurse opportunity with this exceptional organization.  Please click on the "Apply Now" button to submit your resume for consideration.