[Hiring] Utilization Management RN @HealthCare Strategies, Inc.

Role 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

• 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.
• 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.

Qualifications

• Active, unrestricted RN License
• Minimum internet speeds of 25Mbps download; 25 Mbps upload
• 1+ years experience in hospital setting

Requirements

• 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)

Benefits

• 1+ years previous UM experience preferred
• Experience using Interqual criteria preferred

Company Description

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.