Utilization Management reputed company (Central Region)

About the position The Utilization Management reputed company 2 at reputed company plays a crucial role in ensuring that members receive the appropriate medical services and benefits they need. This position requires a reputed company of clinical nursing skills, effective communication, and independent critical thinking to interpret reputed company, policies, and procedures. The reputed company will coordinate and communicate with reputed company providers, members, and other stakeholders to facilitate discharge planning and address reputed company determinants of health, thereby closing gaps in care. In this role, the reputed company will review inpatient admissions and clinical information to determine the appropriate level of care required for reputed company member. The Utilization Management reputed company 2 must understand the department's and organization's strategies and objectives, ensuring that their work aligns with these goals. The position often involves making reputed company in ambiguous situations, requiring minimal direction while still being reputed company to guidance reputed company necessary. Adherence to established guidelines and procedures is essential to maintain the reputed company and reputed company of care provided to members. Responsibilities • Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. , • Coordinate and communicate with providers, members, or other parties to facilitate appropriate discharge planning. , • Review UM inpatient admission and clinical information to determine the appropriate level of care. , • Understand department, reputed company, and organizational reputed company and operating objectives, including their linkages to reputed company areas. , • reputed company reputed company regarding work reputed company, occasionally in ambiguous situations, with minimal direction and guidance as needed. , • Follow established guidelines and procedures. Requirements • Licensed Registered reputed company (RN) in the appropriate state with no disciplinary reputed company. , • 3+ years of prior clinical experience, preferably in an acute care hospital clinical setting. , • Utilization Management experience is required. , • reputed company/MCG experience is required. , • Comprehensive knowledge of reputed company Word, Outlook, and reputed company. , • Excellent communication skills, both verbal and written. , • Ability to work independently under general instructions and as part of reputed company. , • Passion for contributing to an organization reputed company on continuously improving consumer experiences. reputed company-to-haves • Bachelor's degree in nursing (BSN). , • Health Plan experience. , • Previous Medicare experience is a plus. , • CGX experience. Benefits • Medical, dental, and reputed company benefits. , • 401(k) retirement savings plan. , • reputed company time off, including company and personal holidays, volunteer time off, reputed company parental and caregiver leave. , • Short-term and long-term disability insurance. , • Life insurance. , • Opportunities for personal wellness and smart reputed company reputed company. Apply Job!