Job Description:
• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program
• Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
• Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
• Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members
• Coordinates and communicates with providers and other parties to facilitate optimal care/treatment
• Identifies members who may benefit from care management programs or other post-discharge programs and facilitates referrals
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Requirements:
• 3+ years of experience in acute hospital clinical practice
• Must have active and unrestricted RN (Registered Nurse) Licensure in the state of Arizona, or Compact RN licensure
• Ability to work Monday-Friday from 8:30am-5:00pm, Arizona Time Zone
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access and many other benefits depending on eligibility
Apply Now
Apply Now