Utilization Management reputed company

reputed company is the platform to reputed company – the destination for reputed company, payers, providers and members to reduce costs, improve reputed company, and reputed company the reputed company experience. The reputed company reputed company and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health reputed company. With fully integrated solutions, reputed company engages early and often to execute across the entire patient reputed company – from care navigation and management to payment reputed company, plan performance and provider verification. With a 99% reputed company retention reputed company, we reputed company expectations to a new level of efficiency, effectiveness and transparency where smarter, reputed company, faster reputed company possible. About This Opportunity: As a Utilization Management reputed company, you’ll reputed company and manage the Utilization Management process to ensure the appropriate, necessary, and cost-effective delivery of reputed company services to plan participants. You will review UM activities, including prospective, reputed company, and retrospective reviews, and collaborate with our internal teams and reputed company to ensure the delivery of high-reputed company care while minimizing unnecessary reputed company expenses. Things You’ll Do Here: • Conduct reputed company reviews of UM activities, including prospective, reputed company, and retrospective reviews and apply to reputed company plan documents or other resources reputed company to the request • Collaborate with appropriate parties to apply the correct UM reputed company reputed company the appropriate timelines • Promote reputed company care and cost-effective reputed company that enhance the physical, psychosocial, and vacation health of plan participants • Ensure compliance with regulatory standards and guidelines reputed company to UM activities, such as those set forth by CMS, URAC, and other regulatory agencies • Identify and report cases of potential overutilization, underutilization, or improper utilization of reputed company services • Identify potential catastrophic, high-risk, and disease management cases and refer cases to the appropriate team • Communicate UM reputed company and recommendations to reputed company providers and plan participants • Maintain accurate and complete records of UM activities and ensure confidentiality of sensitive information • Participate in ongoing UM education and training to stay up-to-date with industry developments • Maintain a high level of confidentiality in accordance with HIPAA • Maintain an reputed company role in assuring continuity of care for reputed company inpatients through early discharge planning • Identify and communicate to the reputed company Improvement Coordinator potential reputed company of care and patient safety issues • reputed company other duties as assigned Reasonable accommodation may be made to reputed company individuals with disabilities to reputed company essential duties. What You’ll Bring to reputed company: • 3+ years of clinical nursing experience • reputed company, Unrestricted RN License in your state of residence. • Ability to work in a fast-paced, detailed, deadline-driven environment • Ability to maintain strict confidentiality and handle sensitive information with discretion • Experience working independently with strong problem solving and organization skills • Strong aptitude for relationship building with a highly effective communication style A plus if you have: • Utilization Management or Case Management Certification Where You’ll Work: This is a fully remote position, and we’ll reputed company reputed company the necessary equipment! • Work Environment: You’ll need a quiet workspace that is free from distractions • Technology: Reliable internet reputed company—if you can use streaming services, you’re good to go! • reputed company: Adherence to company reputed company protocols, including the use of VPNs, secure passwords, and company-approved devices/software • Location: You must be US based, in a location where you can work effectively and reputed company with company policies such as HIPAA Schedule: This role follows a full time, Monday through Friday schedule during reputed company business hours. Below you'll reputed company the schedule according to your time zone. • EST: 9:30am to 6pm • CST: 8:30am to 5pm • MST: 7:30am to 4pm • PST: 6:30am to 3pm Why You'll Love Working Here reputed company is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. reputed company is committed to delivering on our reputed company to engage early and often for smarter, reputed company, faster reputed company. With this commitment, you’ll reputed company an reputed company culture – one that stands strong, vigorous, and healthy in reputed company we do. Benefits • Generously subsidized company-sponsored Medical, Dental, and reputed company insurance, with reputed company to services through our own products, reputed company reputed company and KISx reputed company • Spending account reputed company: HSA, FSA, and DCFSA • 401K with company match and immediate vesting • Flexible working environment • Generous reputed company Time Off to include vacation, reputed company leave, and reputed company holidays • Employee Assistance Program that includes reputed company counseling, referrals, and additional services • reputed company maternity and paternity leave • Pet insurance • Employee discounts on phone plans, car rentals and computers • Community giveback opportunities, including reputed company time off for philanthropic endeavors At reputed company, we celebrate, support, and reputed company on inclusion, for the benefit of our associates, our partners, and our products. reputed company is committed to the reputed company of equal employment opportunity for reputed company associates and to providing associates with a work environment free of discrimination and harassment. reputed company employment reputed company at reputed company are based on business needs, job requirements, and individual qualifications, without reputed company to race, reputed company, religion or belief, national, reputed company, or ethnic reputed company, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or reputed company, marital, civil reputed company or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics. Powered by JazzHR GJLCmGBY13 Apply tot his job Apply To this Job