RN Utilization Management Reviewer – LTSS & Duals (Remote)

Capital District Physicians Health Plan Inc; Town of De Witt (NY); Remote; USD 62,000 - 118,000; Full time

Job summary

Capital District Physicians Health Plan Inc is seeking a Utilization Management professional to coordinate, integrate, and monitor utilization of physical health services for members. You will review appropriateness, document processes, and collaborate with care teams to ensure timely, high-quality care.

The role includes participation in rotating on-call schedules and potential additional hours per department needs.

Qualifications

• Associates degree and NYS RN license required; Bachelor's degree preferred.

Responsibilities

• Perform pre-service, concurrent and post-service clinical reviews to determine appropriateness of services.
• Plan, implement and document utilization management activities and ensure compliance with policies.

Skills

Clinical experience

UM experience

Microsoft Office

Coding knowledge

Communication skills

Multitasking

Independent work

Member advocacy

Education

Associates degree and NYS RN license

Bachelor’s degree preferred

Tools

Microsoft Office Suite

Job description

Capital District Physicians Health Plan Inc is seeking a Utilization Management professional to coordinate, integrate, and monitor utilization of physical health services for members. You will review appropriateness, document processes, and collaborate with care teams to ensure timely, high-quality care.

The role includes participation in rotating on-call schedules and potential additional hours per department needs.