Overview
PE Global Healthcare are recruiting for a Utilisation Review Nurse for a leading Healthcare Insurance Company based in Cork
This opportunity is a Temporary Contract (12 months)
The primary function of the Utilisation Review Nurse will be reviewing claims to ensure efficiency and cost containment and making decisions on claims utilisation following evaluation of medical guidelines and benefit determination.
Attend meetings to communicate and educate hospital personnel and consultants on the importance of managing patients efficiently in line with best practice.
Responsibilities
Clinical Evaluation of claims to ensure treatment was carried out in the appropriate setting with an appropriate length of Stay and resources
Identify areas of inefficient practice and arrange engagement and collaboration with providers to implement change
Responsible for interrogating reports and analysing Claims Activity to identify and highlight areas for improvement in practice
Attendance at internal team meetings and with hospital and consultants when required
Liaise regularly with clinicians
Update monthly reports on utilisation review
Draft letters, papers and presentations in relation to the clinical area as required
Awareness of market changes in the medical field
Required
Current Registration with the NMBI
Minimum of 3 years acute clinical experience
The ability to be pro-active and decisive in analysing practice and implementing better ways of working creating efficiencies
Be confident when addressing issues with clinicians
Benefits
Monday to Friday hours with extra benefit of Flexi Hours
Hybrid: 40% in office / 60% remote
10% Performance related bonus
Health insurance
Pension
Please call Brenda at PE Global Healthcare on 083 4102611 or email ******
***Please note our clients cannot assist with any visa sponsorship, and candidates must have the correct visa to live and work in Ireland***
PE Global Healthcare specialises in providing contract and permanent Healthcare professionals to the private and public sectors.
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