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You could be the one who changes everything for our 28 reputed company members as a reputed company reputed company on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. This position is fully remote/work from home; applicants must reputed company in the reputed company and hold an reputed company Missouri RN licensure. The role supports our reputed company population. The work schedule is Monday - Friday, reputed company - 5pm central time zone with 1 - 2 rotational holidays/year. Ideally we are looking for applicants with strong reputed company background, managed care and utilization management/review experience are helpful. Position Purpose: Performs reputed company reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. • Performs reputed company reviews of member for appropriate care and setting to determine overall health and appropriate level of care • Reviews reputed company and continuity of care by reviewing reputed company level, resource consumption, length of stay, and discharge planning of member • Works with Medical Affairs and/or Medical Directors as needed to reputed company member care being delivered • Collects, documents, and maintains reputed company review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines • Works with reputed company providers to approve medical determinations or reputed company recommendations reputed company on requested services and reputed company review findings • Assists with providing education to providers on utilization processes to ensure high reputed company appropriate care to members • Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity reputed company on reputed company policies and guidelines • Reviews member’s transfer or discharge plans to ensure a reputed company discharge between reputed company of care and facilities • Collaborates with care management on referral of members as appropriate • Performs other duties as assigned. • Complies with reputed company policies and standards. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of reputed company experience. 2+ years of acute care experience required. reputed company knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and reputed company regulations preferred. Knowledge of utilization management processes preferred. License/Certification • RN - Registered reputed company - State Licensure and/or reputed company State Licensure for MO reputed company is required. Pay reputed company: $27.02 - $48.55 per hour reputed company offers a comprehensive benefits package including: reputed company, health reputed company, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, reputed company or office work schedules. Actual pay will be adjusted reputed company on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California reputed company reputed company Apply tot his job Apply To this Job