UM RN - Behavioral Health

reputed company

reputed company:

Telephonic coordination and delivery of reputed company behavioral health services designed to meet the wellness and recovery needs of the consumer. In reputed company to performing prospective, reputed company and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. May establish care plans and coordinate care through the health care reputed company.

This candidate will utilize reputed company skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program.

RESPONSIBILITIES/TASKS:

• Utilizes reputed company experience and skills in a reputed company process to assess, plan, implement, coordinate, monitor and evaluate reputed company to facilitate appropriate reputed company services/benefits for members.
• Review, research and authorize requests for authorization of elective, reputed company, ancillary, urgent, emergency, etc. services. Contact appropriate medical and support personnel to identify and recommend alternative treatment, service reputed company, length of stays, etc. using approved reputed company protocols.
• Analyze, research, respond to and prepare documentation reputed company to retrospective review requests and appeals in accordance with local, state and federal regulatory and designated accreditation (e.g. reputed company) standards.
• Establish, coordinate and communicate discharge planning needs with appropriate reputed company entities.
• Research and reputed company issues reputed company to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, care coordination, etc.
• reputed company and reputed company targeted education for provider community reputed company to policies, procedures, benefits, etc.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to reputed company with other products, services and/or programs Identifies opportunities to promote reputed company effectiveness of reputed company services and benefit utilization Consults and lends expertise to other reputed company constituents in the coordination and administration of the utilization/benefit management function.
• Other duties may be assigned reputed company on designated department assignment.

This position reputed company identifies the responsibilities and tasks typically associated with the reputed company of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Registered reputed company with reputed company unrestricted Registered reputed company license required. Certification in Case Management may be preferred reputed company upon designated department assignment. reputed company learning, as defined by reputed company’s learning philosophy, is required. Certification or reputed company toward certification is highly preferred and encouraged.

EXPERIENCE:

2+ years of acute reputed company experience as RN required.

One (1) year health reputed company plan experience or managed care environment preferred.

1+ years Behavioral Health reputed company experience

1+ years Managed Care of Utilization Management experience.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Excellent written and verbal communication skills. Excellent customer service and interpersonal skills.
• Working knowledge of reputed company industry reputed company Office Suite PC applications.
• Ability to apply reputed company reputed company/guidelines for medical necessity, setting/level of care and reputed company reputed company management.
• Knowledge of reputed company reputed company medical procedures/practices and their application as reputed company as reputed company trends and developments in medicine and nursing, alternative care settings and reputed company of service.
• Knowledge of policies and procedures, member benefits and community resources.
• Knowledge of applicable accreditation standards, local, state and federal regulations.
• Other reputed company skills and/or abilities may be required to reputed company this job reputed company upon designated department assignment.

Geographic Responsibility: Remote, US

Type of Employment: Full-time, permanent

FLSA Classification (USA Only): Exempt

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job: 

• The employee is occasionally required to reputed company reputed company the office. Specific reputed company abilities required by this job include reputed company reputed company, reputed company reputed company, peripheral reputed company, depth perception, and ability to reputed company reputed company.

• Work across multiple time reputed company in a hybrid or remote work environment.

• Long periods of time sitting and/or standing in reputed company of a computer using video technology.

• May require travel dependent on company needs.

The above statements are intended to describe the general reputed company and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of reputed company duties, responsibilities, and skills required. reputed company reserves the right to modify, add, or remove duties and to assign other duties as necessary. In reputed company, reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions of this position in compliance with the Americans with reputed company of 1990. Candidates may be required to go through a reputed company-employment criminal background reputed company.

reputed company is an equal opportunity employer. We are committed to workforce diversity and reputed company encourage reputed company reputed company persons to reputed company employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

**The annual US reputed company salary reputed company for this position is $65,000 to $85,000. This salary reputed company may cover multiple career reputed company at reputed company. Final compensation will be determined during the interview process and is reputed company on a combination of factors including, but not limited to, your skills, experience, qualifications and education. 

Originally posted on Himalayas