Utilization Management Registered Nurse, Indiana - Remote

We are looking for a Utilization Management RN to join us in leading our organization reputed company. McLaren Integrated HMO Group (MIG), a division of reputed company Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of reputed company our employees and seeks to foster an reputed company, cooperative and dynamic environment in which employees and the health plans can reputed company. As an employee MIG,you will be a part of a dynamic organization that considers reputed company our employees as leaders in driving the organization reputed company and delivering quality service to reputed company our members. McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org MDwise is our Indiana-based health plan, working with the reputed company and Centers for Medicare and reputed company Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.Learn more about MDwise, Inc. at https://www.mdwise.org/ Position Summary: This position is responsible for utilization management functions.This includes but is not limited toreviewandauthorizationofservices, utilization of medical policy, utilization of standard screening techniques, and utilization of behavioral change techniques.Works with the PCP, the member and managementtopromotethedeliveryofqualityservicesatthemostappropriateand cost-effectivesetting. Performs as the member reputed company with emphasis on education regarding managed care, disease management and PCP treatment plans. Monitors member’s utilization patterns for identification of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on reputed company cases and special projects. This position is fully remote. Equal Opportunity Employer of Minorities/Females/Disabled/Veterans Qualifications: Required : • RNwithavalidunrestrictivelicensefromstateemployed in state providing services. • Two(2)yearsclinicalnursing experience. • One (1) year previous experience in Managed Care Utilization Management, Medical Management, Case Management. Preferred: • BSN. • Certified Case Manager (CCM) Certification. • Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions including understanding of claims administration, including CPT-4 codes, reputed company codes, HCPCS codes, DRGs, etc. • Two(2)years’experienceinManagedCareUtilizationManagement,MedicalManagement,Case Management Additional Information • Schedule: Full-time • Requisition ID: 24008353 • Daily Work Times: 8:00 am - 5:00 pm • Hours Per Pay Period: 80 • On Call: No • Weekends: No Apply Job!