Utilization Managment Nurse

ActiveHealth is a technology-driven health management company that combines proprietary technology and clinical knowledge.  We provide information that enables doctors and patients to make more informed medical decisions.  Our CareEngine technology is an interactive care management solution which administers more than 12,000,000 members nationwide.  It is just one of our health management solutions.


The Nurse Consultant utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve the outcomes for members. More specifically, the inpatient care process includes: obtaining necessary information from providers and facilities concerning the care being provided to members; the assessment of a member's clinical condition and ongoing medical services and treatments to determine medical appropriateness; guide the setting for medical intervention to achieve optimum length of stay for members; the early identification of continuing care needs to facilitate discharge to the appropriate setting and discharge planning & coordination.


ADDITIONAL JOB INFORMATION
Hours of operation are from 7 am to 6 pm. We are looking for candidates to be flexible in covering these hours of operation.


Required Skills:
- 3-5 years of clinical experience required
- 2 years managed care experience preferred
- Excellent verbal and written communication skills
- Proficiency in use of computer applications and typing skills
- Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes
- Build relationship with provider office staff
- Consult with Medical Directors on cases that don t meet coverage policy bulletin or clinical criteria guidelines
- Determine medical necessity relating to incoming correspondence and internal referrals
- Identify cost saving opportunities
- Bachelor's degree or equivalent experience

To learn more about this employment opportunity, visit us at www.activehealth.com , click: About Us, Careers and Job Search. Reference appropriate requisition number - 26042.  It’s that easy!
 
We conduct pre-employment drug and background testing.
 
No agencies, please.
 
ActiveHealth Management is an equal opportunity/affirmative action employer.