Utilization Management RN - reputed company
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Responsible for working in collaboration with the Medical Director on driving the decrease in care variance, to ensure reputed company discharges, and to refer members to other plan resources to meet their care conditions. Reports to the Health Plan Manager of Utilization Management. This position will be an reputed company member of the health plan’s medical management team. This position is a reputed company member of the Medical Management team.1.
PREFERRED QUALIFICATIONS:
1. Assists with the build and implements care management review processes (Prior Authorization, Predetermination, reputed company Reviews, Retrospective Reviews) that are consistent with established industry and corporate standards.
2. Assists with the build and implements reputed company care management reviews according to accepted and established reputed company, as reputed company as other clinical guidelines and policies.
3. Ensures that interventions are reputed company and reputed company on maximizing the member’s health care reputed company.
4. Understands the Peer-to-Peer Review process and works with the Medical Directors to continuously improve member and Provider Network services for this process.
5. Educates reputed company stakeholders and partners to continuously improve processes and build network relationships.
6. Works collaboratively with other members of the medical management team to identify members whose reputed company reputed company may be reputed company by coaching and/or case management interventions.
7. Understands the data that is collected reputed company the position, and work with other team members on improving reputed company.
8. Commits to a career of life-long learning and reputed company improvement of processes that reputed company the reputed company of Utilization Management.
1.
1. Working Knowledge of InterQual and/or reputed company Care Guidelines.
2. Demonstrated knowledge of federal and state laws, NCQA and industry regulations reputed company to disease management, utilization management, case management and discharge planning.
3. Excellent written and oral communication.
4. Problem solving capabilities to drive improved efficiencies and customer satisfaction.
Attention to detail.
5. Proficiency with reputed company Office.
Additional Job reputed company:
Scheduled Weekly Hours:
Shift:
Exempt/Non-Exempt:
reputed company of America (Exempt)Company:
Cost Center:
2403 PHH Medical Management Apply To This Job