RN Case Manager - Utilization Care Management

Quartz Health Solutions; Wisconsin; Hybrid; USD 73,000 - 91,000; Full time

Benefits offered by this job

Supportive team and training

Salaried Monday - Friday, no weekends/

Growth opportunities

Hybrid or remote options

Travel within service area

Job summary

Quartz Health Solutions is seeking a licensed RN for a Utilization Management RN Case Manager role in Wisconsin. You will review prior authorization requests, coordinate transitions back to in-network services, and collaborate with physicians, hospital case managers, home health, and SNF staff to ensure optimal patient care.

This is a salaried Monday–Friday position with no weekends or holidays, offering growth opportunities.

Qualifications

• Bachelor’s or Associate degree in nursing with licensure in Wisconsin.
• Unrestricted Wisconsin RN license; Compact state license acceptable.
• 2+ years RN utilization management experience preferred.
• Insurance/managed care experience preferred; some travel required.
• Strong customer service and computer skills.

Responsibilities

• Perform clinical reviews of prior authorization requests.
• Conduct prospective, concurrent, and retrospective medical review for inpatient, SNF and home health services.
• Coordinate care plans and transitions of care.
• Communicate with members, caregivers and providers about reviews.
• Document information and present cases to Medical Director as needed.

Skills

Utilization management

Customer service

Communication skills

Word processing

Excel

UM decision support software

Education

Bachelor’s Degree in Nursing

Associate Degree in Nursing

Tools

UM decision support software

Microsoft Word

Microsoft Excel

Job description

Are you a licensed RN who is interested in using your clinical expertise outside of a clinical or hospital setting? Do you pride yourself in examining all the details of a situation before making important decisions? Are you passionate about ensuring that all patients receive optimal types and levels of care?

If so, please consider joining Quartz as a Utilization Management Registered Nurse (RN) Case Manager. This role is responsible for review of prior authorization requests for treatment and services, coordination of prior authorization for patients transitioning back to in-network services, technology assessment, research, and collaboration with internal and external customers such as primary care physicians, hospital case managers, home health, and skilled nursing facility staff to achieve optimal patient care.

Benefits

• Supportive and experienced team members to assist with training and cases
• Salaried Monday - Friday position with no weekends or holidays.
• Be a part of a stimulating environment by reviewing referrals for a wide range of care services
• Opportunity to obtain additional learning experiences and engage in growth opportunities
• Option to work in-person, hybrid, or remote available
• Compensation pay range: $72,500 – $90,600

Responsibilities

• Perform clinical reviews of prior authorization requests.
• Conduct prospective, concurrent, and retrospective medical review of members requiring inpatient, SNF and home health services.
• Coordination of care and treatment plans, and transition of care.
• Communicate with members, caregivers, and providers for all medical reviews regarding patients.
• Accurately document all relevant information and presents cases to the Medical Director as applicable.
• Maintain knowledge of all commercial, CMS and DHS clinical guidelines and regulatory requirements.

Qualifications

• Bachelor’s Degree in nursing or Associate’s Degree with combination of relevant, equivalent experience.
• Unrestricted State of Wisconsin RN license (Compact State License is acceptable).
• 2+ years of RN utilization management experience in a clinical and/or inpatient setting preferred.
• Insurance or managed care experience preferred.
• Valid State of Wisconsin driver’s license required. Some travel required within Quartz’s service area.
• Exceptional customer service skills.
• Strong computer skills, including familiarity with UM decision support software and Microsoft Word, Excel.
• Ability to function well in a diverse environment that includes clinical, financial, business, and regulatory requirements.

Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. Quartz is a federal contractor and supports a safe, drug-free workplace. All employment offers are contingent upon successful completion of a pre-employment criminal background check and drug screening.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Aff…All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.