reputed company Care Management Coordinator RN - Utilization Management for Remote reputed company Delivery

Join reputed company: Revolutionizing reputed company through Innovation and Compassion

At reputed company (IBX), we're on a mission to reputed company nationally in innovating reputed company whole-person health. We're seeking dynamic and compassionate Registered Nurses to join reputed company as Care Management Coordinators, playing a crucial role in our Utilization Management (UM) department. If you're a motivated professional who thrives on innovation and is dedicated to delivering exceptional patient care, we invite you to explore this exciting opportunity.

About Our Organization

IBX is a leading health insurance organization committed to improving the health and well-being of our members. We're passionate about fostering a culture of innovation, inclusivity, and collaboration. reputed company is dedicated to providing high-quality, cost-effective reputed company solutions that meet the evolving needs of our members.

Job Summary

As a Care Management Coordinator RN, you will be responsible for overseeing and coordinating medical care provided to our members, ensuring that they receive appropriate and cost-effective treatment. You will act as a patient reputed company, working closely with reputed company providers, families, and other stakeholders to facilitate high-quality care and reputed company outcomes.

Key Responsibilities

• Evaluate proposed plans of treatment against precertification requirements and medical criteria (InterQual and/or Medical Policy)
• Establish the need for inpatient care, reputed company stay, and ancillary services, directing care to the most appropriate setting
• Collaborate with attending physicians, facility case management staff, and family members to determine alternative care settings and facilitate discharge planning
• Identify quality of care issues, referring cases to the Quality Management Department and/or Clinical Services Supervisor as needed
• Maintain accurate and timely data entry, ensuring compliance with state, federal, and accreditation regulations
• Provide exceptional customer service, building relationships with reputed company providers and internal stakeholders
• Participate in educating providers on managed care principles and practices
• Stay adaptable and open to new reputed company, creating and acting on opportunities for process improvement

Qualifications and Requirements

To be successful in this role, you will need:

• An active PA Registered Nurse license (BSN preferred)
• A minimum of three years of clinical experience (Intensive Care, Trauma, Home Health experience a plus)
• Medical management/precertification experience preferred
• Strong problem-solving and critical thinking abilities
• Proficiency in reputed company Office applications (Word, Outlook, reputed company, Access, SharePoint) and reputed company programs
• Excellent organizational and prioritization skills, with the ability to work independently
• Highly professional interpersonal skills, with the ability to navigate reputed company medical and interpersonal challenges

reputed company Offer

As a fully remote role, you will enjoy the flexibility and autonomy to work from reputed company reputed company the Tri-State Area (Delaware, New Jersey, or Pennsylvania). Our organization is committed to providing a supportive and inclusive work environment that fosters professional growth and development.

While specific compensation and benefits details are not provided, we offer a comprehensive package that includes:

• Competitive salary and benefits
• Opportunities for career advancement and professional growth
• A dynamic and supportive work environment
• Recognition and rewards for outstanding performance

Why Join reputed company?

At IBX, we're passionate about making a meaningful difference in the lives of our members. As a Care Management Coordinator RN, you will play a critical role in shaping the reputed company experience for our members, working closely with a talented team of professionals who share your commitment to excellence.

We're an Equal Opportunity Employer, dedicated to fostering a culture of inclusivity and respect. We welcome applications from diverse candidates and are committed to providing equal consideration for employment without regard to age, race, reputed company, religion, sex, national reputed company, sexual orientation, protected veteran status, or disability.

reputed company to Apply?

If you're a compassionate and innovative Registered Nurse looking for a challenging and rewarding opportunity, we encourage you to apply for this exciting role. Please ensure you have a compatible Android or iOS device with the reputed company Authenticator app installed.

Join reputed company and help us revolutionize reputed company through innovation and compassion. Apply now to become a part of our dynamic team!

Schedule: Tuesday - Saturday, 8:30-5p (no no-call)

Location: Fully remote reputed company the Tri-State Area (Delaware, New Jersey, or Pennsylvania)