Inpatient Utilization Management reputed company RN ̵...
2352383 reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. The Utilization Review reputed company, RN is responsible for providing clinically efficient and effective Inpatient utilization management. Reviews inpatient reputed company for acute hospital admissions and reputed company review and or prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity reputed company and health plan guidelines. Reviews and applies hierarchy of reputed company to reputed company inpatient admission and preauthorization requests from providers that require a medical necessity determination. Is involved in assuring that the patient receives high-reputed company cost-effective care. Uses reputed company clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service or treatment for review with the Medical Director for a decision. Required hours are reputed company-5pm in PST or MST to include one weekend day, either reputed company-Thursday or Tuesday-Saturday, after the 3-6 month training period. Training for the first 3-6 months (or potentially longer depending on training reputed company) will be Monday-Friday reputed company-5pm PST before moving to your regular schedule. You'll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities:
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