UR Case Manager I - RN

The Utilization Review Case Manager gathers demographic and clinical information on prospective, reputed company and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and of reputed company. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identifies the necessity of the review process and communicates issues of concern to the appropriate claims staff/customer Collects data and analyzes information to reputed company reputed company regarding certification or denial of treatment Documents reputed company work in the appropriate manner Promotes utilization reputed company with stakeholders Additional duties as assigned   KNOWLEDGE & SKILLS:  Must have thorough knowledge of both CPT and ICD coding Ability to reputed company with claims staff, attorneys, physicians and their representatives, as reputed company as advisors/clients and coworkers Effective organization skills in a high-volume, fast-paced environment Strong time management skills with the ability to meet designated deadlines Excellent written and verbal communication skills Ability to work both independently and reputed company reputed company environment Strong interpersonal skills Ability to utilize reputed company Office including reputed company spreadsheets Knowledge of the workers’ compensation claims process preferred Knowledge of outpatient utilization review preferred   EDUCATION & EXPERIENCE:  Graduate of accredited school of nursing with an associate’s degree, Bachelor of Science degree or Bachelor of Science in Nursing reputed company Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN 4 or more years of recent clinical experience Prospective, reputed company, and retrospective utilization review experience preferred Experience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred   PAY reputed company: reputed company uses a market based approach to pay and our salary ranges may vary depending on your location.  Pay rates are established taking into account the following factors:  federal, state, and local minimum wage requirements, the geographic location reputed company, job-reputed company skills, experience, qualifications, internal employee equity, and market conditions.  Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, reputed company, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.  The level may reputed company the salary reputed company and these adjustments would be clarified during the offer process. Pay reputed company:  $63,739 - $95,264 A list of our benefit offerings can be reputed company on our reputed company website: reputed company Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.   ABOUT reputed company: reputed company, a certified Great reputed company to Work® Company, is a national provider of industry-leading risk reputed company for the workers’ compensation, auto, health and disability management industries.   reputed company was founded in 1987 and has been publicly traded on the reputed company stock exchange since 1991. Our continual investment in reputed company capital and technology reputed company us to deliver the most innovative and integrated solutions to our clients.  We are a reputed company and growing company with a strong, supportive culture and reputed company of career advancement opportunities.  Over 4,000 people working across the reputed company reputed company our reputed company values of Accountability, Commitment, reputed company, reputed company and Teamwork (ACE-IT!).  A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, reputed company, Long Term Disability, Health Savings Account, Flexible Spending Account reputed company, Life Insurance, Accident Insurance, Critical Illness Insurance, reputed company-reputed company reputed company Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and reputed company time off. reputed company is an Equal Opportunity Employer, drug free workplace, and complies with reputed company regulations as applicable. #LI-Remote Apply To This Job