Utilization Management RN

Guidehouse(24 days ago)

HybridFull TimeMedior$81,000 - $135,000Utilization Management

About this role

A Clinical Appeals Nurse at Guidehouse supports utilization management and clinical appeals by applying nursing expertise to ensure reviews align with payer and regulatory standards. The role involves analyzing clinical records and coordinating with multidisciplinary teams to support appropriate care decisions and discharge planning.

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Required Skills

Medical Review
Utilization Management
Care Coordination
Discharge Planning
Clinical Documentation
Critical Thinking
Evidence-Based Guidelines
InterQual
Milliman
Microsoft Office

+2 more

Qualifications

Bachelor's Degree
Registered Nurse (RN)
NY RN License (Preferred)

About Guidehouse

guidehouse.com

Guidehouse is a leading advisory firm that specializes in integrating commercial and public sector solutions to tackle complex challenges faced by clients. As a unique scaled advisory organization, it leverages insights from both government and commercial perspectives within its various industry segments. Guidehouse provides a range of technology and managed services, focusing on key sectors such as healthcare, financial services, defense, and infrastructure. The firm is recognized for its innovative approach to problem-solving, which combines strategic expertise with practical implementation.

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