Required skills & experience (the “must haves” to be considered)
1. Unrestricted RN (BSN required) license
2. 5 years healthcare experience, including 2 years in an acute care setting
3. 3 years utilization review experience at a medicare/medicare advantage plan
4. 2 years of case management or discharge planning experience in an acute care setting, home health, or home hospice
5. Must be comfortable with technology and open to learning new software tools
6. Working knowledge of CMS guidelines (NCDs and LCDs) as well as evidence-based guidelines (i.e Milliman Care Guidelines, MCG)
What you need to know
• Develop an outcome-based care plans, based on the member input and assesses members' clinical and social needs
• Conduct telephone visits to engage and educate members (and their family/caregivers)
• Communicate with hospitals, sub-acute care facilities, and members to assess patients progress and meet with appropriate members of the patient care team/family members
• Opportunity to join one of the most innovative, fast growing health plans in the US
• Great pay/benefits with fantastic company culture
Disclaimer: Drjobpro.com is only a platform that connects job seekers and employers. Applicants are advised to conduct their own independent research into the credentials of the prospective employer.We always make certain that our clients do not endorse any request for money payments, thus we advise against sharing any personal or bank-related information with any third party. If you suspect fraud or malpractice, please contact us via contact us page.