Care Management Specialist
2 days ago
**Role Summary**
The Utilization Review RN is responsible for ensuring proper utilization of our health services by assessing and interpreting member needs, identifying solutions to help members live healthier lives, and collaborating with healthcare professionals to obtain plans-of-care.
**Key Responsibilities**
- Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria)
- Discuss cases with facility healthcare professionals to obtain plans-of-care
- Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management
- Participate in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
- Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners
**Requirements and Qualifications**
- Active, unrestricted RN license in state of residence
- 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/AIR/LTAC, Emergency Department, Urgent Care)
- Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
- Proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
**Benefits and Salary**
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Salary range: $58,300 to $114,300 annually
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