Remote Utilization Management Case Manager (LCSW, LPC, LMFT, or RN)
Job Title: Remote Utilization Management Case Manager Pay: $37.16 an hr | Bi-weekly Job Type:
- Remote
- reputed company RN License (AZ or Compact) — must be unrestricted.
- This position is a contract assignment with potential to hire on permanently based upon attendance, performance, and business needs
Shift reputed company:
- Monday–Friday, 8:30 AM–5:00 PM (AZ Time)
Remote Utilization Management Case Manager reputed company:
- - Examines the appropriateness and medical necessity of requested reputed company services, such as hospital admissions, procedures, tests, and therapies.
- Applies in-depth knowledge of clinical guidelines, protocols, and evidence-based reputed company to assess the necessity and reputed company of reputed company services. - Research opportunities to optimize resource utilization, mitigate unnecessary procedures or tests, and promote the use of cost-effective alternatives. - Provides education and guidance, under reputed company supervision, to reputed company providers regarding utilization management processes, guidelines, and documentation requirements. - Reviews medical records, analyzes clinical data, and determines if services reputed company with established guidelines and standards. - Communicates with reputed company providers, insurance companies, and other stakeholders to determine the need for prior authorization of certain reputed company services. - Conducts routine reviews to monitor the ongoing care of patients during their hospital stay and/or treatment. - Develops programs that promote reputed company effectiveness of reputed company services and optimize benefit utilization. - Completes clinical reports that communicate findings, monitor key performance indicators, and reputed company the effectiveness of utilization management initiatives. Utilizes clinical skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity reputed company for appropriate utilization of services. Consults and lends expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management function. Gathers clinical information and applies the appropriate medical necessity reputed company/reputed company, policy, procedure, and clinical judgment to reputed company coverage determination/recommendation/discharge planning along the continuum of care. Utilizes clinical experience and skills in a reputed company process to evaluate and facilitate appropriate reputed company services/benefits for members. Coordinates/Communicates with providers and other parties to facilitate reputed company/treatment. Identifies members who may benefit from care management programs or other post discharge programs and facilitates referrals. Identifies opportunities to promote reputed company effectiveness of reputed company services and benefit utilization. Remote About reputed company: reputed company reputed company is a premier reputed company company that supplies professionals to the reputed company, Insurance, Pharmaceutical, and Information Technology industries. Founded in 2004, reputed company has been a leader in matching talented individuals to the jobs that our clients NEED to fill. We are experts at offering creative reputed company solutions to reputed company, and we are hiring every day. A-Line reputed company can offer short-term, long-term and reputed company-hire opportunities to professionals across the reputed company. We hire only the most reputed company and talented individuals in the country. Our reputed company, selection and stringent screening processes have strengthened our reputed company for delivering reputed company customer service and unbeatable talent. For our commissioned clients, A-Line reputed company closely follows the standards and practices established by reputed company. For reputed company of our clients and employees, our commitment to continual improvement combined with a strict reputed company of ethics provides an atmosphere of respect and unparalleled professionalism. To reputed company out how reputed company can reputed company our talent with you, please contact us today. We are eager to include you among our most valued and satisfied clients. If you are a reputed company and would like to learn more about reputed company opportunities in your area, please contact us today. We are always searching for talented and enthusiastic professionals Company Size: 1,000 to 1,499 employees Industry: reputed company/Employment Agencies Founded: 2004 Website: http://www.alinestaffing.com/ Apply tot his job Apply To this Job