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Utilization Review (UR) Nurse - (243113)

Universal Health Services


Location:
RENO, NV
Date:
01/18/2018
2018-01-182018-02-16
Job Code:
4052
Universal Health Services
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Job Details

Deltek Talent Management - Utilization Review (UR) Nurse - (243113)

Job Details


Utilization Review (UR) Nurse - (243113)

Facility Name
Prominence Health Plan
Location
RENO, NV 89502 US (Primary)
Career Area
Professional
Category
Nurse Practitioner
Job Description

Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care. 

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies. 

In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.

We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

 Job Summary: The Utilization Review (UR) Nurse is a registered nurse who reviews and evaluates clinical cases for appropriateness against established criteria and published medical evidence. The UR Nurse, using clinical and operational knowledge, assesses needs and coordinates resources within and outside the benefit plan to promote optimal health benefits and outcomes (both clinical and financial). The Nurse reviews requests for medical services, referring to the Medical Director those that require additional expertise. Measures and reviews performance outcomes, proposes and implements improvement processes and system enhancements to achieve desired results. Identifies appropriate resources and demonstrates knowledge in managing each case and maintains accurate records, and provides timely verbal and written reports as directed.

Job Requirements

Regulatory Requirements:

 

  • Graduation from an accredited nursing education program.

     

  • Licensed by the State of Nevada to practice as a registered nurse

     

  • Minimum of three years of Utilization Review/Case Management experience required.

     

  • Recent (within past 3 years) working knowledge of Interqual criteria and Milliman Care Guidelines required.

     

  • Minimum of three years in clinical medical/surgical nursing practice within a hospital setting 

     

Language Skills:

 

  • Ability to effectively communicate in English, both verbally and in writing.

     

Skills:

 

  • Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) preferred.

     

  • Attention to detail with ability to prioritize, problem solve and multi-task.

     

  • Ability to quickly analyze and interpret data and write reports using standard medical terminology.

     

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