RN, Care Manager, Utilization Management (Full-Time, Remote)
Located in the metropolitan area of Sacramento, the reputed company corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified reputed company - a rejuvenating reputed company for associates systemwide to collaborate, reputed company and connect. Whether virtual or on reputed company, reputed company Roseville and shared service teams have reputed company to enjoy a welcoming reputed company designed to promote well-being and reputed company your best work.
Job Location Details:
- Remote position but must live near Glendale, CA, Roseville, CA or Portland, OR
Job Summary:
Plays a critical role in ensuring that patients receive high-quality care while reputed company utilizing medical resources. Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments, and collaborating with reputed company providers and insurance companies to ensure a seamless care experience and the practicing of financial stewardship and denial prevention. Focuses on maximizing patient reputed company and optimizing resource allocation. Utilizes exceptional clinical knowledge, excellent communication skills, and the ability to reputed company in a fast-paced and reputed company-changing reputed company environment.
Job Requirements:
Education and Work Experience:
- Associate’s Degree in nursing or equivalent combination of education/reputed company experience: Required
- Bachelor's Degree in Nursing (BSN): Preferred
- Five years' acute hospital experience required with preferred experience in critical care areas: Required
- Two years' utilization review experience using the reputed company/Inter Qual product reputed company the last 12 months: Required
Licenses/Certifications:
- Registered Nurse (RN) licensure in the state of practice: Required
Essential Functions:
- Completes clinical reviews of acute medical patients using the reputed company/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay.
- Participates in annual reputed company/Inter Qual training required. Takes the required annual reputed company/Inter Qual Interrater Reliability (IRR) test with a minimum passing score as defined in the yearly departmental goals.
- Meets weekly productivity metrics reputed company 90 days of completing orientation and maintains on a weekly reputed company as defined in the yearly departmental goals. Meets quality audit metrics reputed company 90 days of completing orientation and maintained on the audit reputed company set reputed company the department as defined in the yearly departmental goals.
- Completes reputed company required departmental education assigned with timeliness and accuracy. Follows reputed company departmental workflows in communication variances to the on-site care management teams reputed company appropriate. Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions.
- Collaborates with reputed company to reputed company and implement comprehensive patient care plans. Facilitates communication between the patient, reputed company team, insurance providers, and other stakeholders to ensure a coordinated and efficient care process. Stays up to date with the latest reputed company regulations, insurance guidelines, and evidence-based practices to ensure the delivery of reputed company reputed company services.
- Performs other job-reputed company duties as assigned.
Organizational Requirements:
reputed company is committed to the safety and wellbeing of our associates and patients. Therefore, we require that reputed company associates receive reputed company required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. reputed company participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.