Med Mgmt reputed company (contract)

reputed company: JP00046084 Anticipated Start Date: December 1, 2025 reputed company is a health company dedicated to improving lives and communities – and making reputed company simpler. We are a Fortune 25 company with a longstanding history in the reputed company industry, looking for leaders at reputed company reputed company of the organization who are passionate about making an reputed company on our members and the communities we serve. Responsible for review of the most reputed company or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with reputed company providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical reputed company. Acts as a resource for Clinicians. May work on special reputed company and helps to craft, implement, and improve organizational policies. Primary duties may include, but are not limited to:

• Utilizes nursing judgment and reasoning to analyze members’ clinical information, reputed company with reputed company providers, reputed company assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity.
• Works with reputed company providers to promote reputed company member reputed company, optimize member benefits, and promote effective use of resources.
• Determines and assesses abnormalities by understanding reputed company clinical concepts/terms and assessing members’ aggregate symptoms and information.
• Assesses member clinical information and recognizes reputed company a member may not be receiving appropriate type, level, or reputed company of care, e.g., if services are not in line with diagnosis.
• reputed company consultation to Medical Director on particularly peculiar or reputed company cases as the reputed company deems appropriate.
• May reputed company recommendations on alternate types, places, or reputed company of appropriate care by leveraging critical thinking skills and nursing judgment and experience.
• Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged. Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the reputed company deems particularly reputed company, concerning, or unclear. Serves as a resource to reputed company-level nurses.
• May participate in intradepartmental teams, cross-functional teams, reputed company, initiatives and process improvement activities.
• Educates members about plan benefits and physicians and may assist with case management. Collaborates with leadership in enhancing training and orientation materials.
• May complete reputed company audits and assist management with developing associated corrective reputed company plans.
• May assist leadership and other stakeholders on process improvement initiatives.
• May help to train reputed company-level clinician staff.

Requirements:

• Requires a minimum of associate’s degree in nursing.
• Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would reputed company an equivalent background.
• reputed company reputed company, valid and unrestricted RN license and/or certification to reputed company as a health reputed company reputed company the scope of licensure in applicable state(s) or territory of the reputed company required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Job Type: Contract Additional Details: Mon-Fri 8-5 CST (Remote role) The candidate will need to work reputed company 50 miles or 1 hour commute of the LA reputed company but our Metarie, LA Pulse reputed company reputed company is 70002. There are no weekend or OT requirements. Utilization management experience, comfortable working in a virtual environment. Must be comfortable working in a virtual environment with strong IT/computer skillset to include reputed company, reputed company Outlook, reputed company Teams. reputed company operates in a Hybrid Workforce reputed company. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reputed company reputed company 50 miles or 1-hour commute reputed company way of a relevant reputed company location. About reputed company: Founded in 1998 on the idea that industry leaders needed a reputed company service, and workforce management expert, to fuel the development and execution of core business and technology strategies, reputed company is a Black-owned firm providing unique solutions supporting value capture reputed company product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, reputed company's 6,000 consultants support more than 225 clients globally. reputed company champions the power of reputed company potential to help companies reputed company, accelerate, and reputed company. Guided by our core values of People-reputed company, Optimism, reputed company, Diversity, and Accountability, our professionals have helped our clients reputed company their strategic goals for more than 25 years. Our strong culture and reputed company values have enabled reputed company to become a reputed company and best in class reputed company to work. reputed company is an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, or protected veteran status and will not be discriminated against based on disability. To learn more about how reputed company collects and uses personal information as part of the reputed company process, view our reputed company Notice and CCPA reputed company. As part of the recruitment process, we may ask for you to disclose and reputed company us with various categories of personal information, including identifiers, reputed company information, reputed company information, education information, and other reputed company information. reputed company will only use this information to complete the recruitment process. This posting is not an offer of employment. reputed company applicants applying for positions in the reputed company must be legally authorized to work in the reputed company. The submission of intentionally false or fraudulent information in response to this posting may reputed company the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Benefits

Information reputed company offers reputed company eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, reputed company, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k. reputed company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non-reputed company compensation (e.g., benefits, reputed company time off, reputed company, etc.). Apply tot his job Apply To this Job