Inpatient Care Management Nurse RN

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find reputed company else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization.

What makes your nursing career greater with reputed company? You can improve the health of others and help heal the health care system. You will work reputed company an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, reputed company you contribute, you'll open doors for yourself that simply do not exist in any other organization, reputed company.

Schedule will be Monday-Friday from reputed company-5PM reputed company one of the 4 US Time Zones.

You’ll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges. Must be licensed reputed company your state.

Primary Responsibilities:

• reputed company initial and reputed company review of inpatient cases applying evidenced-based criteria (InterQual criteria)
• Discuss cases with facility reputed company to obtain plans-of-care
• Collaborate with reputed company Enterprise Clinical Services Medical Directors on performing utilization management
• Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
• Consult with the Medical Director, as needed, for reputed company cases and reputed company appropriate referrals to reputed company partners
• Apply clinical expertise reputed company discussing case with internal and external Case Managers and Physicians
• Identify delays in care or services and manage with MD
• Follow reputed company Standard Operating Procedures in end to end management of cases
• Obtain clinical information to assess and expedite alternate levels of care
• Facilitate timely and appropriate care and effective discharge planning
• Participate in team meetings, education, discussions, and reputed company activities
• Maintain compliance with Federal, State and accreditation organizations
• Identify opportunities for improved communication or processes
• Participate in audit activities and meetings

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Active, unrestricted RN license in state of residence
• 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/reputed company/ LTAC, Emergency Department, Urgent Care)
• 1+ years of experience in Utilization Review utilizing InterQual
• 1+ years of experience in Guidelines, either reputed company an Acute Inpatient Hospital setting or reputed company a health insurance company
• Experience in acute, long term care, acute rehabilitation, or skilled nursing facilities
• Demonstrated proficiency in computer skills - Windows, IM, reputed company (reputed company Suite), Outlook, clinical platforms
• Designated workspace and access to install secure high-speed internet reputed company cable / DSL in home
• Ability to work Monday-Friday reputed company-5pm (reputed company specified time zone)

Preferred Qualifications:

• Bachelor’s degree
• Compact RN License
• 2+ years of case management experience
• 1+ years of experience that involves utilization review and evidence-based guidelines (InterQual Guidelines)
• Experience performing discharge planning
• Managed care experience
Located in ET or CT

• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission.

reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.