Registered Nurse Utilization Manager
Location: Farmington Connecticut
Description: ConnectiCare Inc. is presently looking of Registered Nurse Utilization Manager right now, this career will be placed in Connecticut. Further informations about this career opportunity please give attention to these descriptions. ConnectiCare
Registered Nurse Utilization Manager â€" RN Utilization Manager
ConnectiCare is currently seeking Registered Nurse Utilization Ma! nagers 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 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 appr! opriate utilization of benefits and/or claim adjudication.
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)
Knowl! edge with Milliman and/or Interqual guidelines preferred
Experience with Medicare preferred
Case management with insurance companies, hospital utilization management, med/surg a plus
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 career, please email us your resume, with salary requirements and a resume to ConnectiCare Inc..
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Thu, 24 Oct 2013 08:35:35 GMT