Position Summary
This role is work from home with the following hours: 4 ten hour shifts in EST, with rotating days off, rotating on-call weekends and holidays
Applicants must be a RN with a compact licensure required with ability to obtain additional licenses as needed.
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
- Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
- Identifies members who may benefit from care management programs and facilitates referral
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Required Qualifications
- 3+ years of clinical practice experience in an inpatient setting required
- RN with unrestricted state licensure required
- Willingness to obtain additional state licenses
- Ability to work rotating weekends
Preferred Qualifications
- Managed care/utilization review experience
- Acute care/critical care experience
- Discharge planning experience
Education
AA Nursing Required
BSN Preferred
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is
$26.01 - $74.78