UM Clinical Reviewer

Centers Plan for Healthy Living; Florida; On-site; USD 60,000 - 80,000; Full time

Job summary

Centers Plan for Healthy Living in New York is hiring a Full Time Registered Nurse, entry level welcome, to join the utilization management team. You will assess and process authorization requests to determine medical necessity and ensure needed care services and member education.

In a multidisciplinary setting, you will help identify members who need additional care or support at home, coordinating with care managers and providers to promote quality of life and community living.

Qualifications

• Active RN license required.
• Entry level RN welcome.
• Excellent written and verbal communication skills.

Responsibilities

• Assess and process authorization requests to determine medical necessity.
• Ensure appropriate care services and member education.
• Collaborate with multidisciplinary team to identify members needing additional home-based care.

Skills

Active RN license

Entry level RN welcome

Job description

One of the fastest growing Managed Long-Term Care company in New York, Centers Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience.

The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical necessity to ensure all care services, member education, and preventative interventions are maintained.

Qualifications:

• Active RN license, entry level RN welcome
• Excellent written and verbal communication skills
• Ability to meet tight deadlines
• Strong problem solving skills
• Proficient in the use of Microsoft office Suite tools

Who We Are:

Centers Plan for Healthy Living’s fundamental mission is to enroll eligible individuals who are either Medicaid or Medicaid/Medicare recipients and optimize their ability to remain in the community rather than being institutionalized. Centers Plan for Healthy Living will accomplish this using a multi-pronged approach to care management including ongoing assessment of members’ care/social needs, developing a “living care plan” that is modified as needed, working with community providers as well as the members and their families/care decision makers. We view the member-centric care team as the collective of providers of care, care decision-makers and Centers Plan for Healthy Living care managers and believe that coordinating high quality clinical and social services will result in better clinical outcomes and independent living for the member.