Utilization Management Nurse-5

About the role

MUSC Community Physicians (MCP), an entity within the Medical University of South Carolina (MUSC), provides healthcare to patients within the rural health network throughout South Carolina. This position conducts utilization reviews to determine if patients are receiving care appropriate to their illness or condition.

Responsibilities

• Monitors patient charts and records to evaluate care concurrent with the patients' treatment.
• Reviews treatment plans and status of approvals from insurers.
• Collects and compiles data as required and according to applicable policies and regulations.
• Consults with physicians as needed.

Requirements

• Bachelor's degree in Nursing from an accredited school of nursing.
• Three years’ work experience as a Registered Nurse.
• Licensure as a registered nurse by the state of South Carolina or a compact state.
• Excellent verbal and written communication skills.
• Familiarity with InterQual or Milliman and Robinson screening criteria desired.
• Prior leadership experience preferred.
• One year of case management and/or utilization management work experience preferred.

Staff hired prior to July 1, 2013, will be grandfathered regarding the education requirement.

Benefits

• Health, dental, vision, and life insurance.
• Employer Sponsored Retirement Plan.
• Paid time off and extended sick leave.
• Paid Parental Leave.
• Disability insurance plan options.
• Continuous professional and clinical training.
• Competitive pay with annual merit increases.
• Wellbeing resources.
• Tuition Reimbursement.
• Employee perks and discounts.
• Employee referral program.
• Flexible schedule options.
• Certification incentive program.

Scheduled weekly hours: 19. Pay rate type: Hourly.