, 40 hours per week

Position: Utilization Review (UR) Nurse

Company Overview:

Telenett is a leading healthcare company based in Honolulu, HI. We provide innovative and high-quality healthcare services to our clients, including insurance companies, hospitals, and healthcare providers. Our mission is to improve the health and well-being of our clients by delivering personalized and cost-effective healthcare solutions.

Job Overview:

We are seeking a highly motivated and experienced Utilization Review (UR) Nurse to join our team in Honolulu, HI. As a UR Nurse, you will play a critical role in ensuring the quality and cost-effectiveness of healthcare services provided to our clients. You will work closely with healthcare providers, insurance companies, and other members of the healthcare team to review and evaluate the medical necessity and appropriateness of treatments and services.

Key Responsibilities:

- Conduct utilization review of medical records, treatment plans, and claims to determine the medical necessity and appropriateness of services provided

- Collaborate with healthcare providers to develop and implement effective treatment plans that meet the needs of patients while also controlling costs

- Review and analyze data to identify trends and patterns in healthcare utilization and make recommendations for improvement

- Communicate with insurance companies and other stakeholders to ensure timely and accurate processing of claims

- Participate in case conferences and provide recommendations for alternative treatments or services when necessary

- Ensure compliance with all regulatory and accreditation standards related to utilization review

- Educate and train healthcare providers on utilization review processes and procedures

- Document all utilization review activities accurately and in a timely manner

- Maintain confidentiality of all patient information and adhere to HIPAA regulations

- Collaborate with other members of the healthcare team to improve processes and outcomes related to utilization review

- Stay current with industry trends and best practices in utilization review and make recommendations for improvement as needed

Qualifications:

- Active RN license in the state of Hawaii

- Minimum of 2 years of experience in utilization review, case management, or a related field

- Strong knowledge of medical terminology, procedures, and treatments

- Excellent analytical and critical thinking skills

- Ability to work independently and collaboratively in a fast-paced environment

- Strong communication and interpersonal skills

- Proficient in using electronic medical record systems and other healthcare software

- Knowledge of regulatory and accreditation standards related to utilization review

- BSN or higher degree preferred

We Offer:

- Competitive salary and benefits package

- Opportunities for professional growth and development

- Supportive and collaborative work environment

- State-of-the-art technology and resources

- Relocation assistance for qualified candidates

Join our team and make a difference in the lives of our clients and the healthcare industry. Apply now to become a Utilization Review Nurse at Telenett in Honolulu, HI!