RN Registered Nurse - Utilization Review - 40 Hours Weekly - HAP Health Alliance Plan
Full Time Benefit Eligible

Schedule: Monday through Friday, 8:00AM to 4:30PM, Hybrid
GENERAL SUMMARY:

The Utilization Review (UR) Nurse ensures services meet member's health needs and promotes the provision of high quality care in the most appropriate and cost-effective setting by identifying, assessing, planning, coordinating, monitoring, and evaluating healthcare services, outcomes, and managing the utilization of Health Alliance Plan (HAP) benefits through activities of medical utilization review and discharge planning. This individual promotes collaboration with the patient care team, such as the Outpatient Case Management team, to ensure a high quality of patient care, reduced length of stay, efficient utilization of resources, and appropriate reimbursement of care and services, including discharge planning assistance and aftercare support. Time may be split betwee...