Remote Behavioral Health RN - Utilization Mgmt

Wellframe; United States; Remote; USD 65,000 - 85,000; Full time

Job summary

HealthEdge in the United States seeks a Telephonic Utilization Management RN for Behavioral Health to coordinate care and perform medical necessity reviews across inpatient, outpatient, and ancillary services. Coordinate care through the health care continuum while maintaining clinical documentation and communication with providers.

The role requires an active RN license, 2+ years acute clinical experience, and 1+ year in Behavioral Health/utilization management; remote work across time zones as

Qualifications

• Active RN license in the United States.
• 2+ years of acute clinical RN experience.
• 1+ year in Behavioral Health and utilization management.

Responsibilities

• Utilizes clinical experience to assess and coordinate appropriate healthcare services.
• Review and authorize requests for elective and urgent services per protocols.
• Prepare documentation for retrospective reviews and appeals to meet standards.
• Coordinate discharge planning and communication with internal/external parties.
• Identify opportunities to improve care and educate providers on policies.

Skills

Written and verbal communication

Customer service

Interpersonal skills

MS Office

Education

Registered Nurse license

Job description

HealthEdge in the United States seeks a Telephonic Utilization Management RN for Behavioral Health to coordinate care and perform medical necessity reviews across inpatient, outpatient, and ancillary services. Coordinate care through the health care continuum while maintaining clinical documentation and communication with providers.

The role requires an active RN license, 2+ years acute clinical experience, and 1+ year in Behavioral Health/utilization management; remote work across time zones as