Care Review Clinician - UR RN

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description:

Are you an experienced Registered Nurse looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities:  

• Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team

- Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.

- Providing utilization review for the Medicaid and Medicare line of business. Primarily inpatient, skilled nurses facilities, rehab, behavioral health, and home healthcare

Hours for this Position:

• Mon-Fri 8:30am-5pm

Advantages of this Opportunity: 

• Competitive salary, negotiable based on relevant experience

• Acquire new skills and broaden your experience / expertise

• Fun and positive work environment

Qualifications/ Requirements: 

• Utilization Review background in either Managed Care of Provider environment (at least one year)

• RN License in Michigan

• Interqual experience (at least one year)

• Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management