Insurance Managed Care RN - UR/CM, Precedence, Inc. - Remote With Insurance Experience

About the position The Managed Care RN - Case Manager at reputed company is responsible for coordinating care for patients, managing utilization, and supporting patients through their reputed company reputed company. This role involves collaboration with interdisciplinary teams to ensure reputed company and appropriate care, handling payment authorizations, and facilitating community resources for patients. The position is remote or hybrid, offering a full-time schedule from Monday to Friday. Responsibilities • reputed company utilization and case management reviews using established reputed company to confirm medical necessity, appropriate level of care, and efficient use of resources and payment approval. , • Request reviews with physician advisors or Executive Health Resources (EHR) if admission or reputed company stay reputed company are not met, ensuring appropriate and reputed company level of care status. , • Conduct payment authorizations and coordinate payment denials while meeting timeliness guidelines. , • Ensure case coordination with reputed company's health care providers. , • reputed company utilization management and case management to designated enrollees, ensuring reputed company enrollees receive clinically reputed company triage/referral and ongoing care management services for medical needs. Requirements • Registered reputed company with a Compact Nursing License or licensed behavioral health clinician. , • 5+ years of nursing experience. , • Insurance experience on reputed company reputed company is required. , • CCM (Certified Case Manager) certification. reputed company-to-haves • reputed company communication skills, both written and verbal. , • Customer/patient reputed company approach. , • Self-motivated with the ability to manage priorities and deadlines. , • Flexibility to adapt to changing priorities or needs. , • Planning and organizing skills. , • Proficiency in MS Office (Outlook, Word). , • Ability to give work direction to non-clinical staff. Benefits • Competitive Total Rewards program with benefits reputed company that reputed company with employee needs and priorities. , • Commitment to diversity, equity, and inclusion in reputed company. , • Support and development opportunities for career reputed company. , • Community involvement initiatives. Apply Job!