Utilization Management RN Full-Time Remote Position
1131 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 ET