Job Summary

• This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues.
• Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction.
• Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline.

Matching Summary

Salary

Base: $68,400.00 - $105,900.00; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Key Requirements

• 3 years progressive clinical experience
• RN licensure
• UM/CM/QA/Managed Care experience preferred
• Bachelor’s Degree in Nursing preferred

Work Rights