Physical Health Registered Nurse

Job not on LinkedIn

🕒 July 14

🐊 Florida, North Carolina, +4 more states – Remote

🐊 Florida – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

💵 $68k - $88.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Vaya Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1972

🛡️ Insurance

💼 Consulting

📦 Logistics

Insurance • Consulting • Logistics

Vaya Health is a North Carolina-based organization that manages services for individuals with behavioral health issues, including mental health and substance use disorders, intellectual and developmental disabilities (I/DD), and traumatic brain injuries (TBI). The organization provides Medicaid services tailored for these populations, focusing on a person-centered approach that connects members to the necessary care and support for their unique health and wellness goals. Vaya Health emphasizes collaboration across various care areas to ensure comprehensive support for its members, fostering healthier communities across the region.

📋 Description

• Responsible for completing clinical reviews for appropriateness, medical necessity, and quality • Applies standardized clinical review criteria to determine medical necessity for service authorization requests • Refers service authorization requests to an appropriate physician peer reviewer when medical necessity criteria are not clearly met • Processes requests for authorization of services including inpatient hospital admissions, re-admissions, inpatient rehabilitation services, skilled nursing admissions, home care /home infusion services, outpatient and/or inpatient services as designated • Communicates and interacts with providers as well as internal and external partners to facilitate and coordinate the activities of the UM process.

🎯 Requirements

• Associate Degree in Nursing required • Bachelor’s Degree in Nursing preferred • Five (5) years of clinical experience preferably across the continuum of care with at least two years of acute care experience • Experience performing utilization management functions in a managed care setting • Proficient at using software programs such as Microsoft Office tools • Active and unrestricted RN License in the State of North Carolina or Nurse Licensure Compact (NLC) license.

🏖️ Benefits

• Vaya Health accepts applications from NC, SC, GA, TN, VA, MD, and FL.