Full-Time
Registered Nurse
Integrated Resources
501-1,000 employees
No salary listed
Harrisburg, PA, USA
In Person
 Medical, Clinical & Veterinary (1) |
|---|
- Associates RN degree required
- Bachelor’s degree preferred
- Two years of experience in managed care quality assurance or utilization review preferred
- RN must have two years of experience in an acute care hospital
- Evaluates clinical information submitted by providers against plan review criteria and benefit guidelines.
- Utilizes clinical information to determine if criteria for medical necessity and benefit guidelines are met.
- Utilizes professional judgment to determine if additional information is required, then follows through to obtain additional information prior to making a decision.
- Documents all pertinent case information and dispositions for approvals and denials.
- Refers all cases failing to meet interqual medical necessity criteria to Medical Director for review and final determination.
- Communicates with providers to initiate/coordinate outpatient services/discharge planning needs for members.
- Acts as a liaison to assure services are provided in the least restrictive, most cost effective and clinically appropriate setting.
- Works with the Utilization Management Manager, the Medical Director and providers to ensure that complete medical information is available to allow utilization management decisions to be made within The Plan’s standards for decision making.
- Identifies potential members who may benefit from case management services and facilitates referral to the program.
- Identifies and resolves any problems that could interfere with provider’s continuity and coordination of care of members and refers unresolved problems to Manager.
- Creates and maintains monthly reports on inpatient activities.
- Performs other related duties and projects as assigned.
- Adheres to ACFC policies and procedures.
- Supports and carries out our Mission & Values
- Bachelor’s degree preferred
- Two years of experience in managed care quality assurance or utilization review preferred
Company Size
501-1,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Edison, New Jersey
Founded
1996
Simplify's Take
What believers are saying
- Certification boosts appeal to quality-focused healthcare organizations.
- Reskilling programs cut time-to-hire amid workforce shortages.
- Positions IRI among 15,000 Joint Commission-accredited elite firms.
What critics are saying
- Certification lapses in 12-18 months from failed onsite review.
- Patient complaints trigger decertification and client losses in 6-12 months.
- AMN Healthcare captures IRI's mid-sized clients in 12-24 months.
What makes Integrated Resources unique
- Joint Commission Gold Seal certifies IRI's staffing compliance since 2009.
- AI tool Nova hybridizes with reskilling to close healthcare skills gaps.
- Focuses on diversity hiring and performance monitoring for elite placements.
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Benefits
Wellness Program
Mental Health Support
Flexible Work Hours
Phone/Internet Stipend
Home Office Stipend
Conference Attendance Budget
Company News
Edison, New Jersey - Integrated Resources Inc. has earned The Joint Commission's Gold Seal of Approval(R) for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.
Integrated Resources Inc. has earned The Joint Commission’s Gold Seal of Approval ® for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.