Utilization Review Coordinator

🕒 Ontem

🦞 Maine, New Hampshire, +1 estados a mais – Remoto

🦞 Maine – Remote 🗻 New Hampshire – Remote 🍂 Massachusetts – Remote

💵 $80.000 - $90.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

Health Plans, Inc.

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 1981

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

A Health Plans, Inc. (HPI) é uma das principais administradoras terceirizadas (TPA) nacionais especializadas em soluções de auto-financiamento para empregadores e corretores de benefícios. A HPI oferece designs inovadores de planos de saúde, incluindo planos de saúde orientados pelo consumidor (CDHP) e precificação baseada em referência, adaptados para atender às necessidades únicas de mercados individuais. Com um compromisso de fornecer análises avançadas e soluções personalizadas, a HPI visa colocar os empregadores no controle dos seus custos de saúde, enquanto melhora a experiência do membro.

Descrição

• Review clinical information to determine medical necessity, appropriate level of care, and length of stay using standardized clinical criteria • Render positive determinations for cases meeting criteria and refer other cases for physician peer review • Gather relevant clinical information from appropriate health care providers • Confirm medical necessity for selected procedures and services • Conduct utilization management for level of care and length of stay • Consult with Peer Reviewers when criteria do not support a positive determination or peer consultation is needed • Screen cases promptly to identify case-management needs and make appropriate referrals • Follow up on outstanding utilization-management issues and inquiries • Collaborate with providers to identify discharge needs and facilitate timely discharge to the appropriate level of care • Communicate with providers and other health care professionals about the Utilization Management process • Maintain case documentation according to policy and procedure • Collaborate with the Manager on professional growth • Apply standardized criteria consistently and maintain satisfactory quality audit scores • Manage work time and caseload efficiently • Adhere to HIPAA policies and procedures

🎯 Requisitos

• Minimum of three years of experience in an acute care clinical setting • Active, current and unrestricted professional licensure as an RN or LPN in Massachusetts, Maine, New Hampshire, or the state of residency • Proficient in Microsoft Office, including Word, Excel, Outlook, and PowerPoint • Knowledge of standardized clinical criteria for medical-necessity and utilization-management reviews • Ability to perform utilization management for level of care and length of stay • Ability to follow HIPAA policies and procedures • Ability to maintain documentation according to policy and procedure • Ability to manage work time and caseload efficiently

🏖️ Benefícios

• Medical, Dental and Vision and Prescription Drug Coverage • Fitness Reimbursement Benefit • Employee Assistance Program • Flexible Spending Account & Health Savings Account • 401(k) • Quarterly Bonuses • Generous Paid-Time Off • Volunteering Opportunities • Educational Assistance • Professional Development Opportunities • Smart casual dress code • Ergonomic desks • Onsite café, office-park trails, and campus gyms when at the Westborough headquarters