Utilization Review Nurse $5000 sign on bonus

Job ID: J113166
Company: Highmark Inc
Location: Wilkes-Barre, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

JOB SUMMARY

This position is eligible for a generous $5,000 sign on bonus!

Highmark Health Plan is a not for profit, company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and the healthcare industry. Our employees work hard, play hard, and give back.

As a Care Manager at Highmark, you will use your clinical knowledge and skills to evaluate appropriate health care services and treatment plans in conjunction with providers. You will be a key contributor to the overall financial, quality, and clinical performance of the organization. The position supports an outcomes-oriented, patient care delivery system, which places the patient at the center of all activities.  You will have the ability to provide a positive financial impact through extensive interaction with physicians, nurses, and other patient care givers to ensure our members receive the most appropriate care. You will be part of a virtual organization with multiple sites and must function well both independently as well as part of a larger team.

Please note this position requires you to complete a brief talent questionnaire. This will be emailed to you to complete after you apply.

This position is eligible to work remotely – please note you will need to come into the office for the first 3 – 4 months for initial training.

ESSENTIAL RESPONSIBILITIES

  • Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline.
  • Function in accordance with applicable state, federal laws and regulatory compliance.
  • Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
  • Promote quality and efficiency in the delivery of care management services.
  • Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework  of applicable laws.
  • Practice within the scope of ethical principles.
  • Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
  • Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes.  Is familiar with the various care options and provider resources available to the member.
  • Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
  • Develop and sustain positive working relationships with internal and external customers.
  • Utilize outcomes data to improve ongoing care management services.
  • Other duties as assigned or requested.

QUALIFICATIONS

Required

  • Active United States RN (Registered Nurse) license
  • 3 - 5 years of related, progressive clinical experience in the area of specialization
  • Experience in a clinical setting

Preferred

  • Bachelor’s Degree in Nursing
  • Experience in UM/CM/QA/Managed Care
  • Certification in utilization management or a related field

SKILLS

  • Working knowledge of pertinent regulatory and compliance guidelines and medical policies
  • Ability to multi task and perform in a fast paced and often intense environment
  • Excellent written and verbal communication skills
  • Ability to analyze data, measure outcomes, and develop action plans
  • Be enthusiastic, innovative, and flexible
  • Be a team player who possesses strong analytical and organizational skills
  • Demonstrated ability to prioritize work demands and meet deadlines
  • Excellent computer and software knowledge and skills

Referral Level: 4

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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