Proper documentation and maintenance of records in proprietary software is required.Adheres to quality standards and UM guidelines.Work closely with management team in the ongoing development and implementation of utilization management programs.Releases utilization management determinations to stakeholders following health plan, regulatory and internal established guidelines.Request additional documentation as needed.Perform UM reviews of medical records and clinical documentation to determine medical necessity for ophthalmology services according to NCD / LCD and Health Plan criteria.Utilization reviews in accordance with federal and state regulations.Intermediate Microsoft Word, Excel, Outlook skills. Strong written and verbal communication skills, with emphasis on proper clinical documentation in English.
#Icare health solutions license#
We value diversity and recognize that the unique qualities of individuals contribute to our strength Requirements:Ĭurrent Active and Unrestricted Florida Board of Nursing License is preferredįoreign Trained Healthcare Professionals are encouraged to apply.ġ years Utilization Review/Utilization Management experience preferredĮxperience applying LCD/NCD and Health Plan clinical criteria:Įxperience and comprehension of standards such as NCQA, URAC, CMS (Medicare/Medicaid) and their application in managed care. We seek employees who are creative-thinkers with fresh insights, who thrive in a dynamic, customer-centric environment. We are patient-focused, and guided by a fundamental purpose to create a better healthcare delivery system where integration and collaboration drives better outcomes.
As part of this responsibility, we are contracted by multiple national and regional health plans to provide eye care services to their members. Our solutions embrace well-care by proactively maintaining and measuring patient health through our primary eye care model. ICare Health Solutions is a Health Services Organization that delivers clinically integrated and coordinated eye care solutions. Engage and build relationships with provider community and instruct on criteria requirements. Strong communication telephonically and face to face. The nurse reviewer will work alongside healthcare providers, and industry professionals to ensure appropriate approval of plan benefits.Ĭases are reviewed based on standard LCD / NCD or plan criteria.Īdherence to industry standards inclusive of CMS, Medicare/Medicaid, NCQA, ACHA, and other regulatory agencies, as applicable to managed care and utilization management is essential.Ībility to complete reviews in a timely manner while assuring best practices and quality outcomes.
Position is responsible for the review of clinical documents to determine medical necessity and appropriateness of requested services. Utilization Review Nurse /Full Time Permanent Position- Remote
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