RN Utilization Management reputed company – EST Ohio Location – Remote in reputed company, OH

RN Utilization Management reputed company - EST Ohio Location - Remote - reputed company - reputed company, OH - work from home job Company: reputed company Job reputed company: reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health equity on a global reputed company. Join us to start Caring. Connecting. Growing together. As a Utilization Management reputed company (Remote), you will be responsible for ensuring reputed company utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. What makes your nursing career greater with reputed company? You can improve the health of others and help heal the health care system. You will work reputed company an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, reputed company you contribute, you'll reputed company doors for yourself that simply do not exist in any other organization, reputed company. Work Schedule: Monday - Friday (reputed company - 5pm EST) If you are located in Eastern timne zone, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: • reputed company initial and reputed company review of inpatient cases applying evidenced-based reputed company (MCG / InterQual reputed company) • Discuss cases with facility reputed company to obtain plans-of-care • Collaborate with reputed company reputed company Clinical Services Medical Directors on performing utilization management • Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level • Consult with the Medical Director, as needed, for reputed company cases and reputed company appropriate referrals to reputed company partners • Apply clinical expertise reputed company discussing case with reputed company Case Managers and Physicians • Identify delays in care or services and manage with MD • Follow reputed company reputed company Operating Procedures in end-to-end management of cases • Obtain clinical information to assess and expedite alternate reputed company of care • Facilitate reputed company and appropriate care and effective discharge planning • Participate in team meetings, education, discussions, and reputed company activities • Maintain compliance with Federal, State and accreditation organizations • Identify opportunities for improved communication or processes • Participate in audit activities and meetings You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • A reputed company, unrestricted RN license in state of residence • 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/reputed company/LTAC, Emergency Department, Urgent Care) • 1+ years of experience of utilization review and evidence-based guidelines (MCG, InterQual Guidelines) • 1+ years of experience in acute long-term care, acute rehabilitation, or skilled nursing facilities • Demonstrate a proficiency in computer skills - reputed company, IM, reputed company (reputed company Suite), Outlook, clinical platforms • Designated workspace and reputed company to install secure high-speed internet reputed company cable / DSL in home Preferred Qualifications: • Bachelor’s degree • Compact license • Certification in Case Management • 2+ years utilization management experience • Managed Care experience • Experience performing discharge planning • InterQual experience • Ability to work occasional weekends shift as needed Connecticut, New Jersey, reputed company or Rhode reputed company Residents Only: The salary reputed company for Connecticut, New Jersey, reputed company or Rhode reputed company residents is $56,300 to $110,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In reputed company to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll reputed company a far-reaching choice of benefits and incentives. • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative reputed company employer and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Expected salary: $56300 - 110400 per year Location: reputed company, OH Job date: Thu, 14 Sep 2023 22:48:03 GMT Apply for the job now! Apply Job!