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Registered Nurse Utilization Review Benefit Review

2 months ago

Murray, United States Intermountain Health Full time
R112588 remote type Hybrid Work locations SelectHealth - Murray time type Full time posted on Posted Today job requisition id R112588 Job Description: SelectHealth is a not-for-profit community health plan serving more than 1 million members in the intermountain west that offers a variety of Medicare, Medicaid, Marketplace Qualified Health Plans and commercial health plans. Utilization review behavior health professional proactively manage inpatient and outpatient utilization to assure that medical care is appropriate, efficient, and medically necessary. Job duties include: Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member. Applies evidence-based guidelines (e.g. InterQual) and medical policies with prior authorization and concurrent reviews and follows the applicable regulatory guidelines (NCQA, CMS) to provide clear and timely communication to members and requesting providers Identifies members for referral opportunities to integrate with other products, services and/or programs Collaborates with physicians, internal staff, members and members' families to assist in expediting appropriate discharge, obtains authorizations, and directs toward medically necessary care. Resolves member, family/caregiver assistance requests. Minimum Qualifications Current RN license in state of practice. Three years clinical nursing experience. One year in Managed Care, Utilization Management, or Case Management. Basic computer skills including word processing and spread sheets. Excellent organizational, written, and interpersonal skills and the ability to anticipate and solve problems and communicate clearly and effectively. RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion. Preferred Qualifications Bachelor's degree in Nursing (BSN). Education must be obtained from an accredited institution. Degree will be verified. Current working knowledge of Medicare, Medicaid and Commercial insurance. Current working knowledge of utilization management and case management techniques. Working understanding of coding or utilization management criteria (i.e., InterQual, CMS manual). Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment. Physical Requirements: Ongoing need for employee to see and read information, assess member needs and view computer monitors. - and - Frequent interactions with providers, members that require employee to verbally communicate as well as her and understand spoken information, needs and issues accurately. Anticipated job posting close date: 09/30/2024 Location: SelectHealth - Murray Work City: Murray Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience.  $39.99 - $59.18 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

           

  As the largest nonprofit health system in the Mountain West, Intermountain Health is dedicated to creating healthier communities and helping our patients and caregivers thrive.     It’s time to think of health in a whole new way, and by partnering with our patients and communities, providing expert care closer to home, and making great health more affordable, we can help more people get and stay well.  We proudly invest back into improving the care we deliver, and our pioneering research is making healthcare more personalized, effective, and affordable.   Serving patients and communities throughout the Mountain West, primarily in Colorado, Utah, Montana, Nevada, Idaho, and Wyoming, Intermountain includes 34 hospitals, 400+ clinics, a medical group, affiliate networks, homecare, telehealth, health insurance plans, and other services - along with wholly owned subsidiaries including Select Health, Castell, Tellica Imaging, and Classic Air Medical.    Our Caregiver Promise: Together, for the healthiest lives    We celebrate the different perspectives, backgrounds, experiences, and identities our caregivers bring to their work every day at Intermountain.  Across all areas of our integrated health system, we proudly share best practices, knowledge, and techniques to better serve our patients, communities, and each other.    Here, you’ll work alongside collaborative and curious minds who will support you, encourage you, inspire you, advocate for you, and challenge you to be your very best.    Our Values    Our value statements are core to our culture.  They reflect the behavior and attitudes that are important to us, are an agreement for how we treat each other, help us make decisions on how to act, and are a promise of what people can expect from us.    Our action-oriented values, inspired and shaped by our own caregivers, speak to what it means to be part of Intermountain. 
  • We are leaders in clinical excellence, delivering safe, best-in-quality care 
  • We believe in what we do, living our mission every day 
  • We serve with empathy, caring for each caregiver, patient, and member with compassion and respect 
  • We are partners in health, collaborating to keep people well 
  • We do the right thing, learning and acting with purpose 
  • We are better together, building community through teamwork and belonging