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Beth Israel Deaconess Hospital - Plymouth
Plymouth, Massachusetts
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Duke University Health System
Durham, North Carolina
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Util Mgmt (UM) Nurse-LVN (CHC)
Utilization Management (UM) nurses will assist in the management of CHC members in assessing authorization needs, proper data entry of authorization in the UM system, and assist with approval of requested services/treatments utilizing nationally recognized clinical criteria. They will handle incoming calls with regarding requests for authorizations or questions regarding the authorization process. They offer alternative and supplemental recommendations for services available in the community. Referral processing of requests for in patient care, Home Health Care, and durable medical equipment requests through coordination of CHC resources. They use their nursing knowledge and background to screen and review clinical informatio
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