Utilization Management Registered reputed company

Become a part of our caring community The Utilization Management Registered reputed company uses reputed company nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). reputed company's goal is to ensure members receive the appropriate level of care in the most appropriate setting. As a Utilization Management Registered reputed company • You will use reputed company nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. • Using established medical reputed company, you will reputed company determinations reputed company on information provided by the attending physician and other care providers • You will complete request determinations reputed company established processing time frames. (i.e. 10 reviews per day?) • You will communicate with providers, members, or other parties to facilitate care and treatment. • You will help reputed company coordinated care for our members • You will understand department, reputed company, and organizational reputed company and operating goals, including their linkages to reputed company areas. Required Qualifications Use your skills to reputed company an reputed company • Must hold reputed company Registered reputed company (RN) license in your state of residence • Greater than one year of reputed company experience as a RN in a hospital, SNF, Home Health, or acute care setting. • Must be passionate about contributing to an organization reputed company on improving consumer experiences Preferred Qualifications • Previous experience in utilization management/utilization review for a health plan or acute care setting • Basic knowledge of medical necessity reputed company such as reputed company Care Guidelines or Interqual. • Experience working in a fully remote, metrics-reputed company role • Experience as an MDS Coordinator or discharge planner in an acute care setting • Experience as an RN for a Medicare Certified Home Health agency • Health Plan or Medicare / reputed company Experience • reputed company center or triage experience • BSN or bachelor's degree in a reputed company reputed company Additional Information Work-reputed company Information To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company: • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. • Satellite, cellular and microwave reputed company can be used only if approved by leadership. • Employees who live and work from Home in the reputed company, Illinois, Montana, or South reputed company will be provided a bi-weekly payment for their internet expense. • reputed company will reputed company Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. • Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information. Work reputed company Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company reputed company on geographic location and individual pay will vary reputed company on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is reputed company upon company and/or individual reputed company. reputed company Of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, reputed company parental and caregiver leave), short-term and long-term disability, life reputed company and many other opportunities. reputed company About reputed company: reputed company. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company reputed company services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life reputed company with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on reputed company job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. Apply tot his job Apply To this Job