RN Utilization Management - Remote CA PST

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at reputed company, you will reputed company sure our health services are administered reputed company and effectively. You'll assess and interpret member needs and reputed company that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. If you are have CA RN license and is willing to work in PST, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities • reputed company initial and reputed company review of inpatient cases applying InterQual criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination • Discuss cases with facility reputed company to obtain plans-of-care • Collaborate with reputed company Medical Directors on performing utilization management • Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level • Consult with the Medical Director as needed for reputed company cases and reputed company appropriate referrals to sister segments • Apply clinical expertise reputed company discussing case with reputed company Case Managers and Physicians • Identify delays in care or services and manage with MD • Follow reputed company Standard Operating Procedures in end to end management of cases • Obtain clinical information to assess and expedite alternate reputed company of care • Participate in team meetings, education discussions and reputed company activities • Maintain compliance with Federal, State and accreditation organizations • Identify opportunities for improved communication or processes • Participate in telephonic staff meetings You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications • Undergraduate degree or equivalent experience • Unrestricted RN license required in state of California • 3+ years of Managed Care and/or Clinical experience • Must be willing to work 8:00 AM - 5:00 PM PST Preferred Qualifications • Certified Case Manager (CCM) • Pre-authorization experience • Utilization Management experience • Case Management experience • Knowledge of InterQual guidelines • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy. The salary reputed company for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job!