Clinical Review Nurse
TurningPoint Healthcare Solutions
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At a glance
Requirements
Credentials this posting asks for.
Job overview
TurningPoint Healthcare Solutions is hiring a Clinical Review Nurse. TurningPoint Healthcare Solutions is seeking a motivated Utilization Review Nurse to join their team. This role involves utilizing critical thinking, clinical expertise, and judgment to perform first-level clinical reviews for medical necessity authorizations. The ideal candidate will work independently, meet deadlines, and possess strong attention to detail, advanced grammar, punctuation, and computer skills. Previous utilization management experience is preferred.
Key focus areas include Perform initial clinical reviews and provide documented recommendations based on appropriate clinical guidelines, Review the initial evaluation and clinical documentation against clinical standards, applicable state regulations and relevant treatment guidelines, and Assist clinical staff in quality improvement projects to provide instructive feedback to clients and providers within scope of practice.
Successful candidates bring Licensed Nurse Practitioner and Registered Nurse. Important skills include Problem Solving, Clinical Expertise, Judgement, Work Independently, Meeting Deadlines, and General Nursing Theory. Preferred (not required): Attention To Detail, Flourish In Fast-Paced Environment, Advanced Grammar, and Advanced Punctuation.
Skills & qualifications
Skills
Qualifications
Full job description
Position: Clinical Review Nurse Location: Lake Mary, FL Job Id: 680 # of Openings: 1 TurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans to improve the quality and affordability of healthcare patients receive. We are looking for motivated individuals who want to be part of our mission and join our team!
As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with established medical criteria to perform first level clinical review for select procedures that require medical necessity authorization. We are seeking individuals who enjoy a challenge, have an ability to work independently and are capable of meeting deadlines. Previous utilization management experience is preferred. In addition to prior experience, the ideal candidate will have an extreme attention to detail, an ability to flourish in a fast-paced environment and advanced grammar, punctuation, and computer skills. This is a fully remote position with multiple shifts available!
Responsibilities
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Perform initial clinical reviews and provide documented recommendations based on the use of appropriate clinical guidelines
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Review the initial evaluation and clinical documentation against clinical standards, applicable state regulations and relevant treatment guidelines
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Assist clinical staff in quality improvement projects to provide instructive feedback to clients and providers within scope of practice
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Resolve patient care issues by working one-on-one with community providers and staff to resolve issues in the determination process
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Provide information by responding to queries of physicians and their practice staff, sorting and distributing messages and documents, and preparing information for determinations
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Improve quality results by studying, evaluating procedures and processes and recommending changes, if needed
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Serves and protects the company by adhering to accreditation standards, professional standards, company policies and procedures, federal, state, and local requirements, and professional and licensing standards Qualifications:
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Licensed Nurse Practitioner (LPN) or Registered Nurse (RN) required
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Comprehensive knowledge of general nursing theory and practices
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Excellent customer service skills and phone etiquette
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Proficient computer skills, including typing and an ability to maneuver through various programs
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Previous Utilization Management experience preferred but not required
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Knowledge of musculoskeletal surgical procedures, cardiac procedures, pain management and/ or wound care is a plus
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Ability to multi-task and manage tasks to completion on a timely basis and in an organized fashion
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Ability to work collaboratively as part of a team Apply for this Position
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