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Remote Utilization Management Nurse Care Manager

Remote:

Full Remote

Contract:

Full time

Salary:

106 - 106K yearly

Experience:

Mid-level (2-5 years)

Work from:

New York (USA), United States

Offer summary

Qualifications:

High School Diploma or GED required, 2-5 years clinical experience required, UM/UR experience in managed care needed, Valid New York State Nursing License (RN or LPN) required.

Key responsabilities:

Manage simple and complex medical cases
Conduct hospital admission certifications and discharge planning
Coordinate quality healthcare services cost-effectively
Evaluate member insurance needs and trends
Perform all activities in compliance with regulations

RCM Health Care Services Human Resources, Staffing & Recruiting SME https://linktr.ee/rcmhealthcare

51 - 200 Employees

See more RCM Health Care Services offers

Job description

Remote Utilization Management Nurse Care Manager for PCS / RN / LPN

Experience working with Personal Care Services (PCS) Programs
Experience providing Utilization Management (UM) within the NYC metro area
A valid New York State Nursing License (RN or LPN)

Position Details:

Schedule: Monday through Friday, business hours
Employment Type: Full-time, Permanent

Location: Remote

Benefits

Generous benefits package, including a Pension Plan
Competitive salary up to $105,500

Overview

The Utilization Management Nurse Care Manager under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Utilization Management Nurse Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.

Job Description

Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established Utilization Management policies, procedures, and protocols.
Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
Interacts and obtains relevant clinical information from members’ PCP and other providers; approves care that meets established criteria; and refers all other cases to the Physician Advisor/Medical Director.
Informs members and provider of Utilization Management determinations and treatment alternatives.
Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
Evaluate member needs for referred cases (from providers or member self-referred).
Assists all departments with the resolution of members’ problems related to utilization management issues.
Performs all Utilization Management activities in compliance with all regulatory agency requirements.
Conducts medical record reviews as appropriate to case management functions.
Participates in Medical Management grand rounds with the Physician Advisor.

Minimum Qualifications

High School Diploma General Equivalency Diploma (GED) required; and
2-5 years’ clinical experience in an acute or applicable care setting.
UM/UR experience in managed care or hospital setting required.
New York State license as Registered Nurse, License Practical Nurse, or Physical Therapist required

Generous benefits package, including a Pension Plan Competitive salary up to $105,500