Clinical Reviewer Nurse

About Integrated Home Care Services, Inc.

Integrated Home Care Services, Inc. (IHCS) delivers a comprehensive Integrated Delivery System in the home environment, encompassing Durable Medical Equipment (DME), Respiratory care, Home Health, and Home Infusion services. With over 30 years of experience, IHCS is recognized as a trusted leader in its field, serving Medicare and Medicaid patients through a certified and accredited network available 24/7. The company emphasizes exceptional patient care, where the needs of patients are prioritized above all.

Role Overview

The Utilization Management Nurse position focuses on ensuring home health care services are provided efficiently, cost-effectively, and in compliance with regulations. This involves a continuous audit and review of patient treatment records to prevent unnecessary or ineffective procedures and ensure appropriate care delivery.

Key Responsibilities

• Conduct concurrent reviews of patients' clinical data to assess treatment efficiency.
• Evaluate precertification requests to confirm medical necessity.
• Collaborate with a multidisciplinary healthcare team to coordinate patient care needs.
• Maintain precise and detailed records of all patient interactions.
• Demonstrate organizational skills and effective interpersonal communication.
• Report updates and findings to the Manager of Utilization Management.

Desired Qualifications

• Active state licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN).
• At least 2 years of prior experience in Utilization Management.
• Proficiency with word processing and spreadsheet software applications.
• Certifications in Utilization Management or Case Management are preferred.

Employee Benefits

• Medical, vision, and dental insurance coverage.
• Short-term and long-term disability insurance.
• Paid holidays exceeding six days annually.
• Paid time off (PTO) benefits.
• Employer-funded life insurance policy.
• 401(k) retirement plan with employer contributions.
• Wellness programs featuring reward incentives.
• Employee recognition and reward initiatives.
• Comprehensive paid training program.

Company Commitment

IHCS fosters a collaborative environment dedicated to high-quality patient service through teamwork. The organization is an equal opportunity employer that embraces diversity and strives to maintain an inclusive workplace for all staff members.