Description

American Traveler is hiring an experienced RN Case Manager/Utilization Review for a health plan setting, requiring RN licensure and 5-10 years of acute and ancillary care experience.

Details

• Onsite position in a corporate health plan environment
• Day shift schedule, Monday through Friday, 40 hours per week
• Focus on utilization management and case management activities for health plan members
• Involves coordinating in-patient and out-patient care management across multiple modalities

Requirements

• Active RN license required
• Case Management certification preferred (CCM)
• BSN preferred
• 5-10 years of acute and ancillary care experience across multiple modalities required
• Prior health plan experience in utilization management and case management activities preferred
• Strong communication skills and experience coaching patients/members through their healthcare journey required

Additional Information

• Manages development, implementation, and evaluation of care management service lines
• Partners with physician advisors, claims, and data analytics teams to support member population outcomes
• Coordinates preventative care, wellness, and nutritional counseling for members
• Collaborates with physicians and staff on quality and performance improvement initiatives related to resource utilization and patient flow
• Ensures member medical conditions meet medical necessity criteria and manages discharge planning communication
• Builds and maintains positive relationships with internal and external customers
• Required vaccinations as a condition of employment, with medical and religious exemptions available