Remote RN - Utilization Management I (Appeals)

CareOregon, Inc.; United States; A distancia; USD 102.000 - 125.000; Jornada completa

Descripción de la vacante

CareOregon, Inc. invites applications for a Registered Nurse - Utilization Management I. This remote role supports UM functions within Clinical Operations, including Benefit Management, Benefit Review, Appeals and Grievances and Health Related Services.

Preference given to candidates in Oregon/SW Washington; team focus includes Appeals and Grievances. Essential duties cover communication with members/providers, documentation, and collaboration with Medical Directors to determine medical

Formación

• Current unrestricted RN license
• Minimum 2 years RN experience
• Preferred: 1+ year RN experience in utilization management or related healthcare setting

Responsabilidades

• Communicate with members and providers professionally according to state and federal requirements.
• Maintain accurate and complete documentation.
• Refer members to care coordination per policies and procedures.
• Collaborate with Medical Directors to determine medical necessity and appropriateness of care.
• Manage authorizations and grievances in line with guidelines.

Conocimientos

Communication skills

Interpersonal skills

Customer service

Critical thinking

Prioritization

HIPAA compliance

Diversity sensitivity

Educación

RN license (current, unrestricted)

Herramientas

Microsoft Office

EMR systems

Descripción del empleo

CareOregon, Inc. invites applications for a Registered Nurse - Utilization Management I. This remote role supports UM functions within Clinical Operations, including Benefit Management, Benefit Review, Appeals and Grievances and Health Related Services.

Preference given to candidates in Oregon/SW Washington; team focus includes Appeals and Grievances. Essential duties cover communication with members/providers, documentation, and collaboration with Medical Directors to determine medical