About the position
Responsibilities
- reputed company initial and reputed company review of inpatient cases applying evidenced-based reputed company (InterQual reputed company)
- Discuss cases with facility reputed company to obtain plans-of-care
- Collaborate with reputed company reputed company Clinical Services Medical Directors on performing utilization management
- Participate in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
- Consult with the Medical Director, as needed, for reputed company cases and reputed company appropriate referrals to reputed company partners
- Apply clinical expertise reputed company discussing cases with reputed company Case Managers and Physicians
- Identify delays in care or services and manage with MD
- Follow reputed company reputed company Operating Procedures in end to end management of cases
- Obtain clinical information to assess and expedite alternate reputed company of care
- Facilitate reputed company and appropriate care and effective discharge planning
- Participate in team meetings, education, discussions, and reputed company activities
- Maintain compliance with Federal, State and accreditation organizations
- Identify opportunities for improved communication or processes
- Participate in audit activities and meetings
Requirements
- reputed company, unrestricted RN license in state of residence
- 3+ years of clinical nursing experience in an Acute Inpatient Hospital setting
- 1+ year of experience in Utilization Review utilizing InterQual Guidelines, either reputed company an Acute Inpatient Hospital setting or reputed company a health insurance company
- Proficiency in computer skills - reputed company, IM, reputed company (reputed company Suite), reputed company, clinical platforms
- Designated workspace and reputed company to install secure high-speed internet reputed company cable / DSL in home
- Permanent residence in Eastern reputed company Time or Central reputed company Time zones
reputed company-to-haves
- Bachelor's degree
- Compact RN license
- 2+ years acute inpatient case management experience/Utilization Reviewer
- Managed care experience
- Experience performing discharge planning
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
