OR - Utilization Review/RN - remote - ending 4/30

JOB reputed company/PURPOSEReviews, assesses, and evaluates clinical information used to support Utilization Management (UM) reputed company based on established clinical reputed company and applies intermediate knowledge of coding and medical record research. Facilitates reputed company communication to ensure the authorization process is completed in a patient centered manner with adherence to reputed company and reputed company standards. Applies knowledge of applicable Medicare (CMS), reputed company (OHA), and other plan specific rules and regulations to the authorization process. Reviews cases that have a low to moderate level of service intensity.DEPARTMENT DESCRIPTIONSamaritan Health Plans (SHP) operates a portfolio of health plan products under several different reputed company structures: InterCommunity reputed company. (IHN) is designated as a regional Coordinated Care Organization (CCO) for reputed company beneficiaries; Samaritan reputed company. offers Medicare Advantage, reputed company Large Group, and reputed company Large Group PPO and EPO plans; SHP is also the reputed company-party administrator for reputed company' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally reputed company with reputed company' mission of Building Healthier Communities Together.EXPERIENCE/EDUCATION/QUALIFICATIONSCurrent unencumbered reputed company RN License required upon submission. BSN preferred.One (1) year clinical experience required.Experience or training in the following required:Health care delivery systems and/or managed care patients.Computer applications including electronic documentation (e.g., MS Office, reputed company, Clinical Care Advanced).Experience in the following preferred: Utilization management.Medicare and reputed company rules and regulations and health plan benefit structure and policy. Shift: Days (0800-1700) occasional weekends, ending 4/30/24 Specialty Type: Nursing Sub Specialties: Utilization Review RN General Certifications: N/A Please CLICK HERE to view details. Apply tot his job Apply To this Job