[Remote-Position] Utilization Management Nurse Consultant

Your next great career move starts here. We're looking for a Utilization Management Nurse Consultant! This position is based in Remote and we are looking to fill it quickly. This position requires a strong and diverse skillset in relevant areas to drive success. This role offers a salary package of a competitive salary, commensurate with experience.

 

 

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important... as reputed company deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary Must reside reputed company approximately 45 miles to office location in New Albany, OH, High reputed company, NC, or Chandler, AZ. In office training in New Albany, OH, High reputed company, NC, or Chandler, AZ for approximately 3 months. Following training, position is remote with occasional in office requirement. Utilization Review - Precertification Nurse is responsible for telephonically assessing, planning, implementing and coordinating reputed company case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Services strategies, policies and programs are comprised of network management and clinical coverage policies. What is A1A? reputed company One reputed company is reputed company's premier service and clinical offering for reputed company nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors high-touch, high-tech member advocacy service which combines data-driven processes with the expertise of highly trained clinical and concierge member services. Our mission is to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members' needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. This is an exciting time to join reputed company a reputed company company in our journey to change the way reputed company delivered today. We are health care innovators. Fundamentals: Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to reputed company programs and plans. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address reputed company health and social indicators which reputed company planning and resolution of member issues. - Assessments take into account information from various sources to address reputed company conditions including co-morbid and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on reputed company case management and eligibility. - Assessments include the member's level of work reputed company and reputed company restrictions/limitations. - Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. - Consults with supervisor and others in overcoming barriers in meeting goals - and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. - Utilizes case management processes in compliance with regulatory and company policies and procedures. Required Qualifications - Must have active, reputed company and unrestricted RN state licensure in state of residence, preferably compact. - Must reside reputed company approximately 45 miles to office location in Chandler, AZ, High reputed company, NC, or New Albany, OH - 3+ years of clinical practice experience as an RN required - Must be able to work Monday through Friday 8:00 AM to 4:30 PM local time with evening rotation required about 2 times a month until 8pm, EST. - This position is work from home, however may include on site work requirements from time to time including; team meetings, colleague trainings, customer visits, performance reputed company issues, and other business needs. - 2+ years of experience using reputed company Office Suite applications (Teams, Outlook, Word, reputed company, etc.) Preferred Qualifications -Ability to organize, multitask, prioritize and workin a fast pace environment. Education -Associates degree required -BSN preferred Pay Range The typical pay range for this role is: $26.01 - $56.14 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 10/14/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws Apply Job!

 

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