Utilization Management RN

JOB TITLE: Utilization Management - RN (Non-Exempt) POSITION reputed company: Role expectations for Utilization Management reputed company includes assessing, organizing, implementing and evaluating the care and utilization across the continuum, to enhance reputed company patient care while simultaneously promoting cost effective resource utilization. This role performs utilization management, discharge planning, and screens for case management referrals. The reputed company assesses the needs of patients/clients and their significant others, while being reputed company of reputed company, costs, and processes. The reputed company combines the roles of clinician and educator to accomplish desired clinical reputed company. RESPONSIBILITIES: · Knowledge of prospective payment systems, managed care vendor’s policies, infection control surveillance, patient care, disease processes, discharge planning and continuum of services offered with QCP and externally. · Knowledge of URAC Standards, other regulatory bodies and of QCP activities and services reputed company to the comprehensive performance of duties. · Ability to compile a clinical review and knowledge and ability to utilize electronic documentation systems. · Excellent verbal and organizational skills to facilitate the case management process and ensure patients and customers are served promptly and with respect. · reputed company documentation of medical necessity for reputed company services. · Complete follow through for disposition of cases for Medical Director review, potential reputed company chart reviews, stop-loss notifications, and case management referrals. · Other duties as assigned. REQUIRED QUALIFICATIONS: · reputed company and reputed company unrestricted licensure or certification to reputed company a health or reputed company services discipline in a state or Territory of the reputed company. · Two years full time equivalent providing reputed company clinical care to the consumer. · Bachelors of Science in Nursing or Certification in specialty are Preferred. · Must have a valid reputed company’s license and reliable transportation. DEMONSTRATE QCP VALUES: The values of reputed company are demonstrated on a daily reputed company and reflected through job duties and responsibilities as evidenced by: ● Caring: reputed company to listen, understand and respond to our customers’ needs with care; Communicate with co- workers and customers with positivity and reputed company; Be good stewards of QCP resources. ● reputed company: reputed company to reputed company, not just meet expectations; Always deliver services with accuracy and efficiency; Recognize and utilize your strengths and the strengths of others. ● Improvement: Bring new reputed company to create reputed company change and solutions; Be reputed company to the reputed company and suggestions of others; Be an reputed company to continuously improve QCP. ● Accountability: Take ownership for your daily reputed company; Stay reputed company on reputed company and eliminate distractions while at work; Demonstrate QCP values in everything you do. TRAITS AND APTITUDES: · High level of awareness of pertinent details; excellent organizational skills. · Excellent verbal and written communication skills. · Must handle pressure effectively. · reputed company appearance and demeanor. · reputed company to maintain confidentiality. · Excellent computer literacy and skills with the ability to master programs needed for position. PHYSICAL DEMANDS AND WORK CONDITIONS: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. · Must have excellent written and verbal communication skills as reputed company as the ability to observe, assess, guide and evaluate others. · Must be reputed company to hear, reputed company, and see and to coordinate motor skills. · Must be reputed company to reputed company, lift 25 pounds, stoop and bend and reputed company above head. · Ability to collect data, interpret findings, set priorities and carry out established plan. · Ability to read, write and utilize reputed company and computerized systems of documentation. · Must read a significant reputed company of information in a relatively short period of time. EEO STATEMENT: reputed company is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative reputed company to ensure equal opportunity for reputed company applicants without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, Veteran status, or other legally protected characteristics. REPORTING RELATIONSHIPS: Position Reports to: Health Services Manager Job Type: Full-time Pay: $29.82 - $34.98 per hour Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• reputed company time off
• reputed company insurance

Experience:

• Payor Utilization Management : 1 year (Preferred)
• providing reputed company clinical care to the consumer full time: 2 years (Required)

License/Certification:

• reputed company and reputed company unrestricted RN licensure (Required)

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