What are the responsibilities and job description for the Remote RN - Case Management and Utilization Management position at Get It - Healthcare?
Job Overview
We are seeking an empathetic and meticulous Registered Nurse (RN) specializing in Utilization Management and Case Management to join our dynamic remote team. In this pivotal role, you will leverage your nursing expertise to ensure the delivery of high-quality care that is both effective and efficient for our patients.
Key Responsibilities
Joining our organization means being part of a team that is dedicated to high-quality, patient-centered care. We provide numerous opportunities for professional development and career advancement, enabling you to make a meaningful impact on patient lives while progressing in your career.
Company Culture And Values
Our company is committed to fostering a supportive and collaborative work environment that values continuous improvement and innovation. We prioritize teamwork and the well-being of our staff, recognizing the vital role they play in providing exceptional patient care.
Employment Type: Full-Time
We are seeking an empathetic and meticulous Registered Nurse (RN) specializing in Utilization Management and Case Management to join our dynamic remote team. In this pivotal role, you will leverage your nursing expertise to ensure the delivery of high-quality care that is both effective and efficient for our patients.
Key Responsibilities
- Conduct comprehensive evaluations of patient cases, utilizing clinical data, established criteria, and payer guidelines to assess medical necessity for admissions, continued stays, and care levels.
- Identify opportunities to improve the cost-effectiveness of care, focusing on aspects such as length of stay, medication management, and diagnostic testing.
- Collaborate with the Medical Director on cases that do not meet established criteria.
- Act as an essential liaison between the case management team, third-party payers, and treatment teams, facilitating clear communication and coordination regarding treatment plans.
- Work closely with healthcare professionals to resolve authorization inquiries and provide education on appropriate care levels and utilization management principles.
- Assist in coordinating alternative treatment settings that provide suitable care while ensuring quality and cost savings.
- Analyze and contribute to the evaluation of utilization patterns and denied cases, preparing reports as necessary.
- Maintain accurate documentation and comply with quality assessment and safety standards.
- Deliver exceptional customer service, fostering a collaborative team atmosphere.
- Strong clinical assessment and critical thinking abilities.
- Excellent communication and interpersonal skills.
- Proficiency in data analysis and reporting.
- Capability to work both independently and collaboratively within a team.
- Knowledge of managed care agreements and payer guidelines.
- Associate’s Degree in Nursing is required.
- An active Registered Nurse (RN) license is mandatory, with preference for Multi-State RN licenses.
- A minimum of three years of relevant clinical experience is necessary, with preferred experience in utilization management or case management.
Joining our organization means being part of a team that is dedicated to high-quality, patient-centered care. We provide numerous opportunities for professional development and career advancement, enabling you to make a meaningful impact on patient lives while progressing in your career.
Company Culture And Values
Our company is committed to fostering a supportive and collaborative work environment that values continuous improvement and innovation. We prioritize teamwork and the well-being of our staff, recognizing the vital role they play in providing exceptional patient care.
Employment Type: Full-Time
