Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.
The Department of Case Management at SUNY Downstate Health Sciences University and University Hospital of Brooklyn seeks a full-time Utilization Review Review Nurse. The successful candidate will:
Utilize Milliman Care Guidelines-to justify the level of care, medical necessity, the severity of illness, and Intensity of Care;
Complete initial clinical reviews and concurrent reviews with submission to the appropriate payors;
Facilitate between Physicians and Managed Care Medical Directors as needed;
Provide appropriate CMS notices(HINN, IMM, MOON);
Collaborate with an interdisciplinary team with denial/authorization management.
Bachelor's Degree in Nursing;
Current NYS RN License.
3-years or more Utilization Review experience
Monday to Friday; from 8:00 a.m. to 4:00 p.m.
Commensurate with experience and qualifications
Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at email@example.com.
Equal Employment Opportunity Statement:
SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer, and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.
Women, minorities, veterans, individuals with disabilities, and members of underrepresented groups are encouraged to apply.
If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at 718-270-3025.
Internal Number: 494537
About SUNY Downstate Health Sciences University
SUNY Downstate's College of Medicine, Health Related Professions, Nursing and its School of Graduate Studies offer students a broad professional education that will prepare them for practice or careers in any location and community. This education provides exceptional opportunities for those students with a commitment to promoting health in urban communities and addressing the complex challenges of investigating and preventing diseases that confront clinicians, educators, and researchers in such an environment. This special aspect of Downstate's unique mission is reflected in the students it attracts and selects, the vast majority of whom are drawn from the New York City Metropolitan area. Many of these students are members of minority and cultural groups underrepresented in the health professions, and/or come from families of first-generation immigrants or from economically disadvantaged backgrounds.