Utilization Management RN: Care Coordination & Review

Community Care; United States; Remoto; USD 85.000 - 110.000; Tempo pieno

Descrizione del lavoro

Community Care is seeking a Registered Nurse to perform utilization review and coordinate care for members across the health care continuum. You will assess medical necessity, document decisions, and collaborate with physicians and care teams to optimize outcomes.

In this role, you will review outpatient, inpatient, and post-acute services, communicate findings to providers, and participate in quality improvement initiatives.

Competenze

• Must possess an active RN license in Oklahoma.
• Graduation from an accredited School of Nursing is required.
• Knowledge of managed care and related benefit plans is essential.
• Strong communication and documentation skills.
• Proficiency with Microsoft Office and EHR systems.

Mansioni

• Performs utilization review of outpatient, ancillary, inpatient and post-acute services.
• Determines medical necessity and appropriateness of services.
• Documents all review determinations and communicates with providers and members.
• Identifies and refers cases not meeting criteria to Medical Director.
• Collaborates with physicians to facilitate care across the health care continuum.
• Performs accurate data entry and communicates information to staff.

Conoscenze

Utilization review

Communication skills

Organizational skills

Time management

Documentation skills

Microsoft Office proficiency

Formazione

Registered Nurse license (Oklahoma)

Graduate from accredited School of Nursing

Strumenti

Microsoft Office Suite

Electronic Health Records

Utilization management software

Descrizione del lavoro

Community Care is seeking a Registered Nurse to perform utilization review and coordinate care for members across the health care continuum. You will assess medical necessity, document decisions, and collaborate with physicians and care teams to optimize outcomes.

In this role, you will review outpatient, inpatient, and post-acute services, communicate findings to providers, and participate in quality improvement initiatives.