Utilization Management Case Manager-Work From Home at New York

A nationally recognized Managed Care Organization in NYC is looking for a Utilization Management Case Manager.

Responsibilities:

• Performs pre-authorization, concurrent and retrospective reviews of Medicare/Medicaid/Commercial members to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter.
• Responsible for compliance, in practice, with regulatory mandates.
• Documents all interventions and telephone encounters with providers, members and vendors in the appropriate system in accordance with established documentation standards to ensure integrity of member services.
• Utilizes nationally accepted standards of practice such as Interqual and other organizational approved resources to assess for appropriateness of care.
• Identifies opportunities and facilitates member utilization of In-Network providers.
• Assesses members physical, psychological and discharge planning needs through the transitions of care via communication with appropriate staff including attending practitioner, utilization review staff, discharge planners, social workers, and coordinates care accordingly.

Requirements

• Registered Nurse
• Associates degree in Nursing
• At least 2 years of utilization management experience serving both Medicaid/Medicare populations.
• Knowledge of the concepts and philosophy of utilization management, along with relevant medical and nursing standards of practice.
• Excellent writing and telephone assessment skills.
• Experience managing large case loads and working in a fast-paced environment.
• Managed care experience strongly preferred.

THIS PERSON WILL TELECOMMUTE AFTER A TRAINING PERIODYOU MUST RESIDE IN THE NYC AREA AND HAVE AN ACTIVE NY LICENSE

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Country: USA, State: New York, City: New York, Company: Green Key Resources.