Steward Health Care
Case Mgt Utilization Review RN - REMOTE
This job is now closed
Job Description
- Req#: 125838
Employer Industry: Healthcare
Why consider this job opportunity:
- Competitive pay
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and outcomes
- Access to comprehensive benefits package
- Possibility of remote work flexibility
What to Expect (Job Responsibilities):
- Utilize a systematic methodology/process to assess, plan, implement, evaluate, and coordinate patient care
- Assist in the development of physician profiles to identify utilization patterns
- Collaborate with healthcare disciplines to ensure appropriate and timely services
- Assess the medical appropriateness, quality, and cost-effectiveness of proposed services
- Communicate with payers to obtain authorization
- Identify and plan strategies to optimize length of stay and resource utilization
What is Required (Qualifications):
- Competency with computer-based charting and other software programs
- Adaptability to change and good organizational skills
- Effective communication skills in English
- Knowledge of criteria for Medicare, Medicaid, HMO, and private insurance coverage
- Ability to advocate for patients
- Leadership skills, including mentoring, coaching, counseling, time management, problem-solving, and strategic planning
- Initiative and proactive approach to problem resolution
- Ability to interact effectively with insurance companies and community healthcare resources
- Ability to work in a stressful, fast-paced environment
- Proficiency in Microsoft Office applications
- Understanding of CMI, patient status, InterQual Criteria, Milliman Criteria, and Transfer DRGs
- Maturity to work independently and remotely
How to Stand Out (Preferred Qualifications):
- 3-5 years of acute medical/surgical experience
- 3-5 years of Case Management experience
- Certification in Case Management (CCM)
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2 million people during more than twelve million physician and hospital visits annually.
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