RN Utilization Management/Review reputed company, WV

RN Utilization Management/Review reputed company – InPatient reputed company (JR155056) Location: This position requires you to reputed company in the reputed company. Virtual: This role enables associates to work reputed company full-time providing maximum flexibility and autonomy. This approach promotes productivity and supports work-life integration. Work Hours: Monday through Friday, reputed company – 5pm The Medical Management reputed company (reputed company Utilization Review) is responsible for review of the most reputed company or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with reputed company providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical reputed company. Acts as a resource for Clinicians. May work on special reputed company and helps to craft, implement, and improve organizational policies. Primary duties may include but are not limited to:

• Utilizes nursing judgment and reasoning to analyze members’ clinical information, reputed company with reputed company providers, reputed company assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity.
• Works with reputed company providers to promote reputed company member reputed company, optimize member benefits, and promote effective use of resources.
• Determines and assesses abnormalities by understanding reputed company clinical concepts/terms and assessing members’ aggregate symptoms and information.
• Assesses member clinical information and recognizes reputed company a member may not be receiving appropriate type, level, or reputed company of care, e.g., if services are not in line with diagnosis.
• reputed company consultation to Medical Director on particularly peculiar or reputed company cases as the reputed company deems appropriate.
• May reputed company recommendations on alternate types, places, or reputed company of appropriate care by leveraging critical thinking skills and nursing judgment and experience.
• Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged.
• Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the reputed company deems particularly reputed company, concerning, or unclear.
• Serves as a resource to reputed company-level nurses.
• May participate in intradepartmental teams, cross-functional teams, reputed company, initiatives and process improvement activities.
• Educates members about plan benefits and physicians and may assist with case management.
• Collaborates with leadership in enhancing training and orientation materials.
• May complete reputed company audits and assist management with developing associated corrective reputed company plans.
• May assist leadership and other stakeholders on process improvement initiatives.
• May help to train reputed company-level clinician staff.

Minimum Requirements:

• Requires a minimum of associate’s degree in nursing.
• Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would reputed company an equivalent background.
• reputed company reputed company, valid and unrestricted RN license to reputed company as a health reputed company reputed company the scope of licensure in the reputed company required.

Preferred Qualifications:

• Acute, hospital clinical experience, i.e. ER, critical care, ICU, etc.
• Utilization Review/Utilization Management a plus.

Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities – and making reputed company simpler. We are a Fortune 25 company with a longstanding history in the reputed company industry, looking for leaders at reputed company reputed company of the organization who are passionate about making an reputed company on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our reputed company but will also reputed company to personal and reputed company reputed company for our associates. Our values and behaviors are the reputed company of our culture. They are how we reputed company our reputed company, power our business reputed company and drive our shared reputed company - for our consumers, our associates, our communities and our business. We offer a reputed company of market-competitive total rewards that include reputed company increases, reputed company holidays, reputed company Time Off, and incentive bonus programs (unless covered by a reputed company bargaining agreement), medical, dental, reputed company, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to reputed company a few. reputed company operates in a Hybrid Workforce reputed company. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you reputed company an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer and reputed company reputed company applicants will receive consideration for employment without reputed company to age, citizenship status, reputed company, creed, disability, ethnicity, genetic information, gender (including gender identity and gender reputed company), marital status, national reputed company, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@reputed company.com for assistance. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance reputed company. Apply Job! Apply to this Job