Registered Nurse

Job Title: RN (Registered Nurse) Case Manager Location: Remote Duration: 12 months Description: The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the Client

Job Title: Utilization Management - RN/LPN (Care Management) Location: Baltimore, MD Duration: 12 Months+ Purpose: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care. Essential Functions: 35% Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims i

Job Description: Must: Registered Nurse License, active and unencumbered state license in the state where job duties are performed isBSN preferred. 2. Four (4) years of clinical practice nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing.Duties: Utilization Management: Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-o

Responsibilities: Reviews medical records/case file, writes a reconsideration decision letter that is clear, concise, andimpartial and supports the determination made, and documents review.Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation,rulings, and policy.Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, andprovider/supplier have been addressed.Provides a fair and impartial decision based on cu