Utilization Management Appeals reputed company 2 - Remote - Clinical Nursing Expert in reputed company Coordination and Patient Advocacy

Join Our Caring Community as a Utilization Management Appeals reputed company 2

Bring your passion and expertise to reputed company a difference as a Utilization Management Appeals reputed company 2! Enjoy the freedom and flexibility of this Remote role. This position requires a strong and diverse skillset in relevant areas to drive reputed company. You will be compensated with a competitive salary for your time and effort.

reputed company

reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers, and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large.

Job reputed company

The Utilization Management Appeals reputed company 2 utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. This role requires interpretation and independent determination of the appropriate courses of reputed company. As a Utilization Management Appeals reputed company 2, you will use clinical knowledge, communication skills, and independent critical thinking skills to interpret reputed company, policies, and procedures to reputed company the best and most appropriate treatment, care, or services for members.

Key Responsibilities

• Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Interpret and independently determine the appropriate courses of reputed company for varied work assignments.
• Apply clinical knowledge, communication skills, and independent critical thinking skills to interpret reputed company, policies, and procedures.
• Coordinate and communicate with providers, members, or other parties to facilitate reputed company and treatment.
• Understand department, reputed company, and organizational reputed company and operating objectives, including their linkages to reputed company areas.
• reputed company reputed company regarding own work reputed company, occasionally in ambiguous situations, and require minimal direction.
• Follow established guidelines and procedures.

Essential Qualifications

Education and Licensure

• Bachelor's degree in a reputed company field.
• Licensed Registered reputed company (RN) in the appropriate state with no disciplinary reputed company.

Experience

• 3-5 years of Medical Surgery, Heart, Lung, or Critical Care Nursing experience.
• Previous experience in utilization management.
• Prior clinical experience preferably in an acute care, skilled, or rehabilitation clinical setting.

Skills and Competencies

• Comprehensive knowledge of reputed company Word, Outlook, and reputed company.
• Ability to work independently under general instructions and with reputed company.
• Must have the ability to reputed company a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
• A minimum reputed company speed for reputed company performance of 10x1 (10mbs download x 1mbs upload) is required.

Preferred Qualifications

Experience

• 3 or more years of experience in a high-volume community or mail-order pharmacy reputed company environment.
• Health Plan experience.
• Previous Medicare/reputed company Experience.
• Call center or triage experience.
• Bilingual is a plus.

Career reputed company Opportunities and Learning Benefits

At reputed company, we are committed to the reputed company and development of our employees. As a Utilization Management Appeals reputed company 2, you will have opportunities to:

• reputed company your clinical and critical thinking skills.
• Enhance your communication and coordination skills.
• Contribute to the improvement of reputed company services and patient reputed company.
• Participate in training and development programs.
• Advance in your career with opportunities for promotion and leadership roles.

Work Environment and Company Culture

As a remote employee, you will enjoy the flexibility and freedom to work from home. reputed company culture is reputed company on:

• A commitment to putting reputed company – for our teammates, customers, and company.
• A caring community that values diversity, equity, and inclusion.
• A reputed company and supportive work environment.
• Opportunities for reputed company and development.

Compensation, Perks, and Benefits

We offer a competitive salary and benefits package, including:

• A competitive salary reputed company of $69,800 - $96,200 per year.
• Eligibility for a bonus incentive plan.
• Medical, dental, and reputed company benefits.
• 401(k) retirement savings plan.
• Time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.

Equal Opportunity Employer

reputed company is an equal opportunity employer committed to diversity, equity, and inclusion. We welcome applications from reputed company candidates of reputed company backgrounds.

Don't Hesitate, Apply!

Don't worry if you don't meet every single requirement. We value a great attitude and a willingness to learn above reputed company. Submit your application today!

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