Utilization Review Nurse - Remote -id-5250
The job you're describing is for a Utilization Management Nurse (UMN) and Personal Health Nurse (PHN) within Conifer Health. Heres an overview of the position: Job Overview: Conifer Health's approach is focused on holistic medical management. The UMN conducts utilization review and pre-certification for various medical services to ensure they are medically necessary and cost-effective. The PHN is responsible for guiding members through their health management process, collaborating with families, physicians, and providers to establish care goals and empower members to manage their own health effectively. Both roles require close interaction with healthcare providers and the ability to balance clinical knowledge with cost-effective care. Key Responsibilities: Review clinical documentation to assess medical necessity. Work within designated timeframes for pre-certification and review processes. Collaborate with the medical team and external vendors to ensure care is provided in the most cost-effective, appropriate setting. Identify risk factors and barriers to discharge for patients. Support quality assurance initiatives and meet performance standards. Provide education and care plans for members to facilitate self-management and informed healthcare decisions. Required Knowledge and Skills: Strong understanding of medical management practices, healthcare regulations, and client needs. Proficiency in Word and email communication. Excellent written and verbal communication skills for professional interactions with physicians, clients, and members. Analytical skills to assess and resolve complex problems in medical management. Organizational skills and the ability to manage multiple priorities. Required Experience and Education: Bachelor's degree in a health-related field. 3-5 years of clinical experience. 5 years of Utilization Management (UM)/Case Management (CM) experience is preferred. Certifications and Licensure: Registered Nurse (RN) license in the state of residence is required. Working Environment and Travel: This is a remote work position with limited travel (up to 5%). Some on-call work required (25-30% on weekends and holidays). Compensation and Benefits: Salary range: $64,168 - $96,262 annually. Benefits package includes health, dental, vision, 401(k) matching, paid time off, and more. Sign-on bonuses may be available for certain positions. Company Overview: Conifer Health is part of Tenet Healthcare and Catholic Health Initiatives. It provides healthcare management solutions to help organizations transition to value-based care, improve quality, and enhance patient experiences. Would you like assistance tailoring a resume or preparing for an interview for this position? Utilization Review Nurse - Remote -id-5250 Apply Job!