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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 ET

HealthCare Strategies, Inc.

Employees 51-200 employees Industry Insurance and Employee Benefit Funds

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