- Remote, United States
- Remote
- Full-time · Associate
- $26–$69 per hour
- 3+ years
Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
Compensation
$26.01 - $68.55
Responsibilities
- Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care.
- Communicate with providers and other parties to facilitate care and treatment.
- Identify members for referral opportunities to integrate with other products, services, or benefit programs.
- Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Requirements
- Diploma RN acceptable
- Associate degree/BSN preferred
- Nice to have: Utilization Management experience