JOB SUMMARY: Performs technical and administrative work required to evaluate the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Licensed RN responsible for clinical review of all acute and subacute services for appropriateness based on medical criteria. This individual is responsible for the management of healthcare resources necessary and appropriate for achievement of desired acute and subacute outcomes and the coordination of alternative levels of care for membership. PRIMARY RESPONSIBILITIES: 1. Performs on-site and/or telephonic review of acute and subacute services. 2. Predicts and plans for patient’s needs from pre-admission, through acute and subacute care and post-discharge, in collaboration with the member. 3. Utilizes pre-approved criteria and guidelines to validate medical necessity of continued stay and appropriateness of treatment and discharge planning. 4. Acts in conjunction with the appropriate manager(s) on a daily basis to assess the inpatient census for appropriate alternative health care service needs. 5. Coordinates with appropriate discharge planning team members, facility utilization management department, physicians and members to coordinate timely discharges. 6. Strives to maintain quality care while effectively utilizing resources. 7. Identifies and reports any quality or utilization issues to the Medical Director. 8. Acts in conjunction with the clinical team related to discharge planning e.g., home care, hospice care, rehabilitation care, special program care, transitional care, occupational therapy, speech, respiratory and physical therapy, durable equipment and disposable supplies. 9. Documents all activities in the appropriate system(s) on a timely basis. 10. Participates in rounds with the Medical Director. Education and Experience: • Currently licensed RN with three years experience in health care, case management, discharge planning, utilization management, or behavioral health. • Two years of Utilization Management or Hospital/Acute care experience required. • Experience working on the community level and with community agencies preferred. Certification and Licensure: • Current State RN license • Certified Professional Utilization Review (as required by Plan) • Certified Case Managers a plus. • Must possess a valid driver’s license and access to a motor vehicle. Contact: Jason Edwards Jason@NurseResolutions.com 888.411.2228 x 200 Location: Las Vegas, NV 89128 Compensation: $70,000-$75,000 depending upon experience OK for recruiters to contact this job poster. Phone calls about this job are ok. Please do not contact job poster about other services, products or commercial interests. nevada