BHM Healthcare Solutions
  • 16-Sep-2021 to 15-Nov-2021 (EST)
  • Tampa, FL, USA
  • 26-30
  • Hourly
  • Part Time

BHM is a national Independent Review Organization (IRO), established in 2002, that provides medical and behavioral health review to health plans, health systems, hospitals, and other insurers nationally that have monthly minimum volume needs. BHM promises to meet client-requested turnaround times and deliver high quality, accurate results.

The utilization management nurse position supports BHM's Peer Reviewers by assessing and synthesizing clinical documentation, charts, medical records, and, if applicable, peer-to-peer consultation notes to develop clinical summaries and perform quality audits. All these efforts help ensure that healthcare services are administered with quality, cost efficiency, and within compliance. If you like clinical administration work, then BHM has a position for you!

Schedule:

  • Regular schedule is Monday-Friday. Weekends and holidays are on an "on-call" rotating schedule. In office position with work from home (WFH) option once training completed; work performance and proficiency achieved

Salary:

  • $55,000 - $65,000 per year. Compensation is commensurate with level of experience.
  • Eligible for a 1-time bonus after successful completion of training in 3-4 modules with demonstrated proficiency.
  • Eligible for salary increase after successfully trained and work knowledge acquired, generally 6-8 months after hire date.

Fundamentals:

  • Partakes in a structured, well-designed training program
  • Utilizes clinical experience, criteria/guidelines, and policies and procedures in support of ensuring timely and accurate medical necessity/benefit determinations
  • Analyzes information to support the process of rendering appropriate medical necessity and/or benefit determinations
  • Synthesizes clinical information and develops clinical review summaries
  • Utilizes clinical skills to support the documentation and communication of medical and behavioral health service determinations
  • Conducts quality Peer Reviewer audits for medical and behavioral health reviews
  • Acts as a liaison between Peer Reviewers and clients as well as a support for Peer Reviewers, including training and mentoring
  • Employs strong customer service skills, both verbally and written, and client understanding to ensure a premiere experience for client interactions
  • Performs well and thrives in a fast-paced team environment
  • Enjoys clinical administration type of work

Qualifications:

  • Education
    • BS degree in Nursing required
  • Licensure
    • Active RN clinical license required
  • Experience
    • Minimum 6 months experience of direct patient care preferred
    • 1-2 years' experience processing clinical peer reviews for Utilization Management program preferred
    • Utilization Management or Case Management certification preferred

For more information about BHM, please visit www.bhmpc.com.


BHM Healthcare Solutions
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