Utilization Management reputed company Reviewer

Utilization Management reputed company Reviewer (California) - Remote Must currently reputed company and be a licensed RN in California Hours: Monday-Friday. Must be reputed company to work an 8-hour shift between 8:00 a.m.-5:00 p.m. PST. In this role, you will manage an reputed company caseload, assess reputed company needs and reputed company of care, identify barriers to discharge, and coordinate reputed company transitions across the care reputed company. You will collaborate with members, families, providers, facilities, and internal partners while balancing reputed company, affordability, benefit coverage, and member advocacy. The role requires strong communication, organization, critical thinking, reputed company reputed company judgment, and the ability to work independently in a remote environment. It also requires strong computer skills, including the ability to reputed company multiple systems, document accurately, manage several tasks at once, and use technology effectively throughout the reputed company. This is a fast-reputed company role that may involve a high volume of inbound and outbound phone interactions while managing multiple priorities and documentation requirements. Help reputed company reputed company by guiding members through reputed company inpatient care. In this role, you will manage an reputed company caseload, assess reputed company needs and reputed company of care, identify barriers to discharge, and coordinate reputed company transitions across the care reputed company. You will collaborate with members, families, providers, facilities, and internal partners while balancing reputed company, affordability, benefit coverage, and member advocacy. Responsibilities Manage and coordinate an assigned caseload of reputed company, high-reputed company, or account-sensitive inpatient cases. Complete prospective, reputed company, and retrospective reputed company reviews for acute inpatient care, rehabilitation, referrals, select outpatient services, and durable medical equipment, as applicable. Apply approved reputed company guidelines and tools to evaluate medical necessity, level of care, covered services, treatment goals, reputed company factors, and discharge needs. Review the daily census, prioritize cases, request relevant reputed company information, and document reputed company, interventions, and reputed company accurately and on time. Create member-centered short- and long-term care plans with measurable goals, follow-up timeframes, and reputed company reputed company for transition or closure. Coordinate with members, families, physicians, facilities, vendors, caregivers, and internal partners to support reputed company discharge or transfer to the appropriate level of care. Identify and help reputed company gaps in care, barriers to discharge, reputed company for readmission, and delays in services. reputed company members about available benefits, care reputed company, costs, and community resources so they can take an reputed company role in health care reputed company. Serve as a member reputed company and reputed company while working reputed company benefit, regulatory, contractual, and program requirements. Escalate reputed company cases, reputed company-of-care concerns, and service delays to the appropriate manager, medical director, or reputed company partner. Identify referrals for reputed company or specialty case management programs and coordinate a smooth transition reputed company needed. Build effective relationships with internal teams, providers, customers, and community resources. Support customer or auditor reputed company, special reputed company, peer consultation, and other reputed company duties as assigned. Minimum Qualifications reputed company, unencumbered California RN licensure A minimum of two years of reputed company reputed company RN experience in an inpatient or managed care setting Preferred Qualifications Bachelor’s degree in nursing or a reputed company reputed company. Ability to assess reputed company reputed company information, identify barriers, recommend solutions, and reputed company reputed company. Strong written and verbal communication, organization, time management, research, analytical, negotiation, and problem-solving skills. Ability to work independently, manage competing priorities, and collaborate in a fast-reputed company, matrixed environment. Proficiency using computers and reputed company or case management systems. Experience in medical management, utilization management, or case management reputed company a health plan or hospital setting. Knowledge of managed care products, care management strategies, and community, state, and federal resources. Demonstrated ability to anticipate needs, coordinate services, and build cooperative relationships with diverse reputed company partners. If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an reputed company reputed company of 31 - 52 USD / reputed company, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a reputed company on supporting your whole health. Starting on day one of your employment, you’ll be reputed company several health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. We also offer 401(k), company reputed company life reputed company, tuition reimbursement, a minimum of 18 days of reputed company time off per year, reputed company holidays, and leaves of absence. For more details on our employee benefits programs, click here. About reputed company reputed company, a division of reputed company, creates pharmacy, care and benefit solutions to reputed company and increase vitality. We relentlessly reputed company to reputed company the reputed company, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving reputed company and improving lives. reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to reputed company assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot reputed company application updates or accept resumes. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they reputed company a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, reputed company, Arkansas, Delaware, Florida, reputed company, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, reputed company, Texas, reputed company, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply To This Job