Registered Nurse Utilization Manager job at ConnectiCare Inc. in Farmington

ConnectiCare Inc. is currently seeking to employ Registered Nurse Utilization Manager on Thu, 24 Oct 2013 08:35:35 GMT. ConnectiCare Registered Nurse Utilization Manager â€" RN Utilization Manager ConnectiCare is currently seeking Registered Nurse Utilization Managers in the Farmington, CT area . Utilization Managers will facilitate the accurate administration of benefits, maximize optimal appropriate utilization related to medical necessity, and place of service to foster high quality care in a cost effective...

Registered Nurse Utilization Manager

Location: Farmington Connecticut

Description: ConnectiCare Inc. is currently seeking to employ Registered Nurse Utilization Manager right now, this job will be placed in Connecticut. More details about this job opportunity kindly read the description below. ConnectiCare
Registered Nurse Utilization Manager â€" RN Utilization Manager
ConnectiCare is currently seeking Registered Nurse Utilization Managers in the Far! mington, CT area . Utilization Managers will facilitate the accurate administration of benefits, maximize optimal appropriate utilization related to medical necessity, and place of service to foster high quality care in a cost effective environment.

Job Responsibilities:
Researches, develops, communicates and evaluates medical management strategies including potential for alternatives with multi-disciplinary team (including member/family and provider/physician organization) to ensure high quality cost effective continuum of care.
Coordinates activities of multi-disciplinary team involving provider/ physician organizations, family members, health management programs and community resources to ensure flow of care plan.
Manages authorization process for services, alternative levels of care, procedure precertification and out-of-network services.
Reviews and investigates member and provider requests, and appeals to determine appropriate utilizati! on of benefits and/or claim adjudication.
Enters and maint! ains critical data in system meeting defined time frames and performance standards, to facilitate appropriate claim adjudication and identification of trends in UM which negatively impact cost and/or quality. Works collaboratively with physician organization, as require, in the analysis and dissemination of utilization/case management information to achieve desired outcomes.
Actively participates in new provider orientations, and ongoing provider and member education programs.
Performs other related projects and duties as assigned.
Hours: department is open 8am-5pm Monday-Friday.

Qualifications:
Bachelor’s Degree in Nursing preferred or equivalent combination of education and experience (Associate’s Degree in Nursing acceptable)
Registered Nurse licensed in Connecticut or willing to obtain licensure
Minimum 4 years of clinical experience (acute care)
Strong computer skills (Microsoft products)
Knowledge with Millima! n and/or Interqual guidelines preferred
Experience with Medicare preferred
Case management with insurance companies, hospital utilization management, med/surg a plus

  • Candidates with experience in home care, utilization review, workman’s comp, genetic testing, coding, DME, outpatient procedures, or Medicare are welcome to apply!
Benefits:
Salary Range Mid-Point - $74,000
Medical insurance, including a high deductible plan compatible with health savings accounts
Dental insurance
401K contributions
Disability (short and long term) insurance
Tuition reimbursement
Employee referral bonus
Plus more…
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to ConnectiCare Inc..

If you interested on this job just click on the Apply button, you will be redirected to the official website

This job starts available on: Thu, 24 Oct 2013 08:35:35 GMT



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