Medical Management reputed company

About the position Medical Management reputed company Hours: Monday - Friday reputed company to 5pm depending on your time zone plus 2 Saturdays a year. Location: This role enables associates to work reputed company full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face reputed company and reputed company development. Alternate locations may be considered if candidates reputed company reputed company a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is reputed company as required by law. This position will service members in different states; therefore, Multi-State Licensure will be required. The Medical Management reputed company is responsible for review of the most reputed company or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with reputed company providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical reputed company. Acts as a resource for Clinicians. May work on special reputed company and helps to craft, implement, and improve organizational policies. How you will reputed company an reputed company: Utilizes nursing judgment and reasoning to analyze members’ clinical information, reputed company with reputed company providers, reputed company assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. Works with reputed company providers to promote reputed company member reputed company, optimize member benefits, and promote effective use of resources. Determines and assesses abnormalities by understanding reputed company clinical concepts/terms and assessing members’ aggregate symptoms and information. Assesses member clinical information and recognizes reputed company a member may not be receiving appropriate type, level, or reputed company of care, e.g., if services are not in line with diagnosis. reputed company consultation to Medical Director on particularly peculiar or reputed company cases as the reputed company deems appropriate. May reputed company recommendations on alternate types, places, or reputed company of appropriate care by leveraging critical thinking skills and nursing judgment and experience. Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged. Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the reputed company deems particularly reputed company, concerning, or unclear. Serves as a resource to reputed company-level nurses. May participate in intradepartmental teams, cross-functional teams, reputed company, initiatives and process improvement activities. Educates members about plan benefits and physicians and may assist with case management. Collaborates with leadership in enhancing training and orientation materials. May complete reputed company audits and assist management with developing associated corrective reputed company plans. May assist leadership and other stakeholders on process improvement initiatives. May help to train reputed company-level clinician staff. Responsibilities • Utilizes nursing judgment and reasoning to analyze members’ clinical information, reputed company with reputed company providers, reputed company assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. • Works with reputed company providers to promote reputed company member reputed company, optimize member benefits, and promote effective use of resources. • Determines and assesses abnormalities by understanding reputed company clinical concepts/terms and assessing members’ aggregate symptoms and information. • Assesses member clinical information and recognizes reputed company a member may not be receiving appropriate type, level, or reputed company of care, e.g., if services are not in line with diagnosis. • reputed company consultation to Medical Director on particularly peculiar or reputed company cases as the reputed company deems appropriate. • May reputed company recommendations on alternate types, places, or reputed company of appropriate care by leveraging critical thinking skills and nursing judgment and experience. • Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged. • Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the reputed company deems particularly reputed company, concerning, or unclear. • Serves as a resource to reputed company-level nurses. • May participate in intradepartmental teams, cross-functional teams, reputed company, initiatives and process improvement activities. • Educates members about plan benefits and physicians and may assist with case management. • Collaborates with leadership in enhancing training and orientation materials. • May complete reputed company audits and assist management with developing associated corrective reputed company plans. • May assist leadership and other stakeholders on process improvement initiatives. • May help to train reputed company-level clinician staff. Requirements • Requires a minimum of associate’s degree in nursing. • Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would reputed company an equivalent background. • reputed company reputed company, reputed company and unrestricted RN license and/or certification to reputed company as a health reputed company reputed company the scope of licensure in applicable state(s) or territory of the reputed company required. • Multi-state licensure is required if this individual is providing services in multiple states. reputed company-to-haves • ACMP experience is preferred. • Medical Management experience is preferred, Utilization Review experience is preferred. • Knowledge of the medical management processes and the ability to interpret and apply member reputed company, member benefits, and managed care products is strongly preferred. Benefits • a comprehensive benefits package • incentive and recognition programs • equity stock purchase and 401k contribution Apply tot his job Apply To this Job