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Job Requirements of Utilization Review Nurse:
-
Employment Type:
Contractor
-
Location:
Tennessee, IL (Onsite)
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Utilization Review Nurse
Careers Integrated Resources Inc
Tennessee, IL (Onsite)
Contractor
Job Title: Utilization Review Nurse
Job Location: This is a remote position within our plan states, IL, TX, NM, OK, MT, TN.
Job Duration: 06+ Months (Possibility of extension)
remote within one of our plan states, IL, TX, NM, OK, MT or TN
Hourly pay Rate - $41.45 - $45/Hr. on w2
Job Description:
Roles & Responsibilities:
Minimum requirements:
Job Location: This is a remote position within our plan states, IL, TX, NM, OK, MT, TN.
Job Duration: 06+ Months (Possibility of extension)
remote within one of our plan states, IL, TX, NM, OK, MT or TN
Hourly pay Rate - $41.45 - $45/Hr. on w2
Job Description:
- Not a Case Management or Member-Facing role.
- This is Prior Authorization / Utilization Management with provider-facing responsibilities.
- Interviews will be quick.
- Training & Work Expectations
- Work hours: Must work CST, with 10 AM–3 PM CST being the peak workload period.
- No time off allowed during training—even one day missed will cause setbacks.
- Required to be on camera during training and post-training.
- After training, candidates are paired with someone for support; case loads start only after training.
- Equipment & WFH Setup
- Candidates must use client-issued equipment once received.
- Personal devices should not be used.
- No cell phone use during training.
- Maintain professional WFH decorum, especially for those working full-time or with family responsibilities
Roles & Responsibilities:
- Nurse Case Management Senior Analyst. For this position, Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members.
- Also assist those members experiencing the burdens of illness and injury. The Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs within case load assignments of a defined population.
- The Case Manager will promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced.
- Ability to work independently and effectively communicate to internal and external customers in a telephonic environment.
- Responsibilities:
- Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history, current health status, and assess the options for optimal outcomes.
- Promote consumerism through education and health advocacy.
- Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare. Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
- Implements, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis.
- Adheres to professional practice within Product of licensure and certification quality assurance standards and all case management policy and procedures.
- Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
- Demonstrates sensitivity to culturally diverse situations, clients and customers.
Minimum requirements:
- Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Compact RN license a required for this role.
- Two years full-time equivalent of direct clinical care to the consumer.
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