Utilization Management RN Full-Time Remote Position

Utilization Management RN (M-F FROM YOUR HOME OFFICE) HealthCare Strategies Description Do you want to work from the comfort of your own HOME? Do you want to work for a progressive company that is a leader in their industry? F/T 40-hour/week Position Monday - Friday Hours: 9am - 6pm ET . JOB DESCRIPTION: * Responsible for the collection of personal and clinical information on participating Plan members for the purpose of: * Providing patient education services. * Rendering initial determinations of medical appropriateness for communication to the health benefit plan. * Identifying individuals whose health and/or expenses may be positively affected through application of Large Case Management. SPECIFICS: * Perform telephonic Clinical Assessments * Obtain appropriate information from health care provider and or patient or family regarding planned procedure, admission, continued stay or discharge plan. * Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services. * Identify and refer individuals whose health and/or expenses may be positively affected through the application of Case Management. * Document each call completely, accurately and promptly into the computer system. * Follow documented policies and procedures for the handling of confidential materials and/or patient specific information. * Answer direct telephone calls related to medical services in order to determine if prior authorization is required for the requested ser