Utilization Review Nurse

Kaztronix was founded in 2002 with a vision to impact the staffing industry by making the finest talent and consulting solutions easily accessible to organizations spanning numerous industries. Simply put, we source and qualify the best industry talent available, providing flexible solutions to meet the business objectives of our clients.

* Use clinical knowledge to assess pre-authorization cases (elective outpatient; DME; diagnostics; post procedures) * Meet regulatory turn around times for case determinations and notifications * Enter acute medical hospitalizations electronically * Utilize policies, Interqual and Millman criteria against clinical information received to determine medical necessity * Find PAR providers for members requiring specialty consultation; assist members set up appointments * Work with the Medical Director on case denials and expedited cases * Assist with creating workflows/updating policies * Contacting a number of stakeholders telephonically (physician; members; facilities) * Create letters of approval to facilities/providers/members * Manage a caseload of 40-50/week * Projects as assigned

**Skills:** * Excellent verbal, written, interpersonal, communication, and problem-solving skills. Exceptional customer service skills. Solid nursing * assessment abilities; knowledge of managed care concepts; Solid understanding of Utilization Review including application of Interqual criteria; Ability to handle large volumes of work with meeting deadlines; organizational ability to handle several priorities at once **Education:** * Active RN IL license; Indiana licensure a plus; Knowledge of UR concepts with Medicare/Medicaid population