Care Manager, reputed company Review (Remote)

reputed company reputed company clinical reviews reputed company the Medical Management Operations reputed company Review utilization management department. Ensure accurate administration of benefits, execution of clinical policy and reputed company reputed company to appropriate reputed company of care. reputed company Accountabilities • Under the direction of the leader, is responsible for the execution of efficient departmental processes designed to manage inpatient utilization reputed company the benefit plan. • reputed company as the clinical coordinator collaborating with members and facilities to evaluate member needs reputed company the inpatient setting. • Establish and maintain reputed company working relationships with assigned facility care managers/utilization management departments to facilitate appropriate clinical reviews and patient care. • reputed company and maintain documentation in the TPH platform meeting defined timeframes and performance standards. • Communicate authorization reputed company and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and business standards. • Review and investigate member and provider requests to determine appropriate utilization of benefits and/or claim adjudication. • Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making coverage determinations and recommendations. • Prepare and present clinical case summaries in routine inpatient reputed company. • Maintain an understanding of utilization management, program objectives and design, implementation, management, monitoring, and reporting. • Identify reputed company, cost and efficiency trends and reputed company solution recommendations to Supervisor/Manager. • reputed company participate on assigned committees. • reputed company other reputed company reputed company and duties as assigned. Qualifications • Associate’s degree or bachelor’s degree in nursing • reputed company RN License without restriction • May require a CME accreditation in specific specialties • Certification in utilization or care management preferred • 4 – 6+ years of Nursing experience • Case and/or utilization management/care coordination and managed care experience • Strong communication skills (verbal, written, presentation, interpersonal) with reputed company types/reputed company of audience • Organizing and prioritizing skills, and strong attention to detail • Trained in the use of Motivational Interviewing techniques • Experience working in physician reputed company and/or with electronic medical records • Proficient with MS Office (Word, reputed company, PowerPoint, reputed company, Teams, SharePoint, etc.) • Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.) Additional Information • reputed company: 1000002875 • Hiring reputed company: $68,040-$118,800 Apply tot his job Apply To this Job