Care Manager Rn - Utilization Management (um) Remote

Highmark Health

Working At Home, PA, United States
Base: $68,400.00 - $105,900.00; bonus/equity: not ...
Review appropriateness of health care services
Apply criteria to ensure resource utilization
Identify opportunities for referral
This job implements effective utilization management strategies including review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, and identification of opportunities for referral to a Health Coach/case management

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, and identification of opportunities for referral to a Health Coach/case management.
  • 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

This job implements effective utilization management strategies including review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, and identification of opportunities for referral to a Health Coach/case management.

Salary

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

Skills & Requirements

Must-have

  • Review appropriateness of health care services
  • Apply criteria to ensure resource utilization
  • Identify opportunities for referral
  • Monitor and analyze health care delivery
  • Respond to customer inquiries
  • Implement care management review processes

Nice-to-have

  • Proactive provider and member education
  • Develop positive working relationships
  • Enthusiastic, innovative, and flexible
  • Team player with strong analytical skills

Key Requirements

  • 3 years progressive clinical experience
  • RN licensure in PA or eNLC
  • Experience in UM/CM/QA/Managed Care
  • Bachelor’s Degree in Nursing preferred
  • Certification in utilization management preferred

Work Rights

Not specified

Tailored Resume

Cover Letter