{"id":15780,"date":"2025-01-13T11:49:09","date_gmt":"2025-01-13T11:49:09","guid":{"rendered":"https:\/\/carkendra.com\/phemployment\/?p=15780"},"modified":"2025-01-13T11:49:09","modified_gmt":"2025-01-13T11:49:09","slug":"case-management-utilization-review-rn-remote-id-4026","status":"publish","type":"post","link":"https:\/\/carkendra.com\/phemployment\/case-management-utilization-review-rn-remote-id-4026\/","title":{"rendered":"Case Management Utilization Review RN &#8211; REMOTE ID-4026"},"content":{"rendered":"<p>Care Manager Position<\/p>\n<p><strong>Key Responsibilities<\/strong>:<\/p>\n<ul>\n<li>Assess, plan, implement, evaluate, and coordinate patient care from pre-hospital to post-hospital care using a systematic approach.<\/li>\n<li>Develop physician profiles to identify utilization patterns (over\/under).<\/li>\n<li>Support the goals of Steward Health Care and comply with regulatory standards.<\/li>\n<li>Collaborate with healthcare professionals to ensure timely, quality care.<\/li>\n<li>Evaluate the medical appropriateness, quality, and cost-effectiveness of hospital, medical, and surgical services.<\/li>\n<li>Work with the multidisciplinary team to manage patient benefits and obtain authorization from payers.<\/li>\n<li>Develop strategies to optimize inpatient length of stay and resource use.<\/li>\n<\/ul>\n<p><strong>Required Knowledge &amp; Skills<\/strong>:<\/p>\n<ul>\n<li>Competency with computer-based charting and clinical\/non-clinical software.<\/li>\n<li>Ability to adapt to change and demonstrate strong organizational skills.<\/li>\n<li>Effective reading, communication, and presentation skills.<\/li>\n<li>Knowledge of Medicare, Medicaid, HMO, and private insurance criteria.<\/li>\n<li>Critical thinking and patient advocacy skills.<\/li>\n<li>Leadership qualities: mentoring, coaching, time management, and problem-solving.<\/li>\n<li>Proactive approach to problem resolution and ability to work in a fast-paced environment.<\/li>\n<li>Proficient in Microsoft Office (Excel, Word, etc.).<\/li>\n<li>Understanding of clinical criteria, CMI, patient status, InterQual, Milliman Criteria, and Transfer DRGs.<\/li>\n<li>Ability to work independently and remotely.<\/li>\n<\/ul>\n<p><strong>Education\/Experience\/Certification<\/strong>:<\/p>\n<ul>\n<li><strong>Education<\/strong>: Bachelor&#8217;s degree required; Master&#8217;s degree preferred.<\/li>\n<li><strong>Experience<\/strong>: 3-5 years of acute medical\/surgical experience + 3-5 years of Case Management experience.<\/li>\n<li><strong>Licensure\/Certification<\/strong>: RN license required; Certification in Case Management (CCM) strongly preferred.<\/li>\n<li><strong>Technical Skills<\/strong>: Strong knowledge of Microsoft Office Suite (Word, Excel, Access, PowerPoint).<\/li>\n<li><strong>Other<\/strong>: Knowledge of healthcare delivery settings and industry standards.<\/li>\n<\/ul>\n<p>This Care Manager position offers an opportunity to collaborate with a multidisciplinary team, support patients through their hospital stay, and ensure the efficient use of healthcare resources. Strong communication, organizational, and leadership skills are crucial in this fast-paced environment.<\/p>\n<h4 style=\"text-align: center;\"><strong>Case Management Utilization Review RN &#8211; REMOTE ID-4026<\/strong><\/h4>\n<p><a href=\"https:\/\/joblagii.com\/job-application\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-1129 aligncenter\" src=\"https:\/\/uk.jobworld.info\/wp-content\/uploads\/2025\/01\/apply-now-300x119.webp\" alt=\"\" width=\"300\" height=\"119\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Care Manager Position Key Responsibilities: Assess, plan, implement, evaluate, and coordinate patient care from pre-hospital to post-hospital care using a systematic approach. Develop physician profiles to identify utilization patterns (over\/under). Support the goals of Steward Health Care and comply with regulatory standards. Collaborate with healthcare professionals to ensure timely, quality care. Evaluate the medical appropriateness, &#8230; <a title=\"Case Management Utilization Review RN &#8211; REMOTE ID-4026\" class=\"read-more\" href=\"https:\/\/carkendra.com\/phemployment\/case-management-utilization-review-rn-remote-id-4026\/\" aria-label=\"Read more about Case Management Utilization Review RN &#8211; REMOTE ID-4026\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-15780","post","type-post","status-publish","format-standard","hentry","category-blog"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/posts\/15780","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/comments?post=15780"}],"version-history":[{"count":2,"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/posts\/15780\/revisions"}],"predecessor-version":[{"id":15782,"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/posts\/15780\/revisions\/15782"}],"wp:attachment":[{"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/media?parent=15780"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/categories?post=15780"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/carkendra.com\/phemployment\/wp-json\/wp\/v2\/tags?post=15780"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}