Utilization Management RN Full-Time Remote Position
Utilization Management RN (M-F FROM YOUR HOME OFFICE)
HealthCare Strategies
Description
Do you want to work from the comfort of your own HOME? Do you want to work for a progressive company that is a leader in their industry? F/T 40-hour/week Position Monday - Friday Hours: 9am - 6pm ET . JOB DESCRIPTION: * Responsible for the collection of personal and clinical information on participating Plan members for the purpose of: * Providing patient education services. * Rendering initial determinations of medical appropriateness for communication to the health benefit plan. * Identifying individuals whose health and/or expenses may be positively affected through application of Large Case Management. SPECIFICS: * Perform telephonic Clinical Assessments * Obtain appropriate information from health care provider and or patient or family regarding planned procedure, admission, continued stay or discharge plan. * Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services. * Identify and refer individuals whose health and/or expenses may be positively affected through the application of Case Management. * Document each call completely, accurately and promptly into the computer system. * Follow documented policies and procedures for the handling of confidential materials and/or patient specific information. * Answer direct telephone calls related to medical services in order to determine if prior authorization is required for the requested services. * Retrieve and acknowledge messages requesting medical services from voicemail. * Complete all medical necessity reviews and communicate outcomes to providers within the appropriate time frames. * Provide educational materials and direct callers to community services when indicated. * Provide coverage for professional colleagues. REQUIREMENTS: * Active, unrestricted RN License * Minimum internet speeds of 25Mbps download; 25 Mbps upload * 1+ years experience in hospital setting ABILITIES/SKILLS: * Strong verbal communication skills * Problem-solving and decision-making skills * Ability to carry out detailed written or verbal instructions independently * Proficiency with Microsoft Office Suite (Outlook, Word) PREFERRED: * 1+ years previous UM experience* Experience using Interqual criteria.
During our over 40 years in business, HealthCare Strategies has earned a reputation for delivering quality services as a medical management provider and now through technology platforms by offering next generation, informatics-driven, health management services used singularly, or in tandem, with our highly effective clinical programs. Monday - Friday; 40 hours/week. Hours: 9a - 6p ETOriginally posted on