RN Case Manager-Utilization Care Mgmt

Overview

Are you a licensed RN who is interested in using your clinical expertise outside of a clinical or hospital setting? Do you pride yourself in examining all the details of a situation before making important decisions? Are you passionate about ensuring that all patients receive optimal types and levels of care?

If so, please consider joining Quartz as a Utilization Management  Registered Nurse (RN) Case Manager. This role is responsible for review of prior authorization requests for treatment and services coordination of care for patients transitioning back to in-network services,  technology assessment, research, and collaboration with internal and external customers such as primary care physicians, hospital case managers, home health and skilled nursing facility staff to achieve optimal patient care.

Benefits:

• First shift with regular, full-time hours and no weekends or holidays.
• Supportive and experienced team members to assist with training and cases
• Be a part of a stimulating environment by reviewing referrals for a wide range of care services
• Opportunity to obtain additional learning experiences and engage in growth opportunities
• Compensation pay range: $72,000 – $88,000

Responsibilities

• Perform clinical reviews of prior authorization requests.
• Conduct prospective, concurrent, and retrospective medical review of members requiring inpatient, SNF and home health services.
• Coordination of care and treatment plans, and transition of care.
• Communicate with members, caregivers, and providers for all medical reviews regarding patients.
• Accurately document all relevant information and presents cases to the Medical Director as applicable.
• Maintain knowledge of all commercial, CMS and DHS clinical guidelines and regulatory requirements.

Qualifications

• Bachelor’s Degree in nursing or Associate’s Degree with combination of relevant, equivalent experience.
• Unrestricted State of Wisconsin RN license (Compact State License is acceptable).
• Additional licensure in IL, MN, or ability to obtain preferred. 
• 2 years of RN utilization management experience in a clinical and/or inpatient setting (preferred, not required) - willing to train the right candidate.
• Insurance or managed care experience preferred.
• Valid State of Wisconsin driver’s license required. Some travel required within Quartz’s service area.
• Exceptional customer service skills.
• Strong computer skills, including familiarity with UM decision support software and Microsoft Word, Excel.
• Ability to function well in a diverse environment that includes clinical, financial, business, and regulatory requirements.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. Quartz is a federal contractor and supports a safe, drug-free workplace. All employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

Salary : $72,000 - $88,000