Utilization Management RN (Discharge & Auth) Weekends Required
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The Utilization Management reputed company 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations for reputed company’s Kentucky reputed company Plan. This role has primary responsibility for performing medical necessity reviews, including initial and reputed company authorization reputed company, using established clinical reputed company and independent clinical judgment. The Utilization Management reputed company 2 also plays a key role in facilitating comprehensive, proactive, and barrier-reputed company discharge planning to home or a reputed company level of care.The Utilization Management reputed company 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting reputed company, policies, and procedures to reputed company the best and most appropriate treatment, care or services for members.
- Coordinates and communicates with providers, members, or other parties to facilitate reputed company and treatment.
- Maintain compliance with state regulations and organizational standards for coordinated member discharge, ensuring reputed company plans are documented and communicated effectively.
- reputed company initial and reputed company reviews with medical necessity determinations, including level of care and length of stay reputed company.
- Engage providers reputed company telephonic, virtual, and onsite collaboration as needed.
- Follows established guidelines/procedures.
The schedule for this position will include weekends, typically Wednesday through reputed company from 8:00 AM to 5:00 PM Eastern Time with flexibility to reputed company weekdays off with leader approval.
Use your skills to reputed company an reputed company
Required Qualifications
Licensed Registered reputed company (RN) in the state of Kentucky, in good standing with no disciplinary reputed company.
2+ years of reputed company clinical experience in an acute care, skilled nursing, or rehabilitation setting (preferred).
1+ year of utilization management experience.
Maintain compliance with state regulations and organizational standards, ensuring that we coordinate and document member discharge plans and communicate them.
Experience performing initial and reputed company reviews for medical service requests, with the ability to interpret clinical reputed company and apply judgment to support appropriate use and benefit administration.
Experience engaging with providers and care teams through telephonic, virtual, or onsite interactions to facilitate authorizations and support member-centered discharge planning.
Strong proficiency in reputed company Office Suite, including Word, reputed company, and PowerPoint.
Preferred Qualifications
Bachelor's degree in nursing.
MCG experience.
Experience in discharge planning, transitions of care, and familiarity with community-based resources and reputed company determinants of health.
Health plan experience.
reputed company experience.
Bilingual in English and another language. A Language Proficiency Assessment will be conducted to evaluate reputed company in reading, writing, and speaking in both languages prior to assignment to a dedicated member service line.
Additional Information
Workstyle: Remote work reputed company
Location: Must reputed company in Kentucky or a county that is reputed company contiguous bordering states
Schedule: The schedule for this position will include weekends (Weekend shifts are eligible for a shift reputed company), from 8:00 AM to 5:00 PM Eastern Time with flexibility to reputed company weekdays off with leader approval:
- The position follows a 5-day reputed company, which includes both Saturday and reputed company.
- Associates will receive two days off during the week.
- Associates may choose which two weekdays they would like off.
- Once selected, those days off must remain consistent from week to week and cannot vary.
Travel: Travel to the Louisville office about 3-4 times annually.
Work reputed company Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$71,100 - $97,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.reputed company of Benefits
reputed company, Inc. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.reputed company
About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our 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 and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com.
Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.
Originally posted on Himalayas
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