Qualifications:

Education:
Bachelors of Nursing (BSN) Preferred
License/Certification:
Accredited/Certified Case Manager (ACM or CCM) designation strongly preferred
Registered Nurse (RN) required

Experience:

Two years of acute care, utilization management, or payer experience required
Ability to function autonomously maintaining a high level of clinical and
professional accountability
Demonstrates skill in creative problem solving, facilitation, collaboration,
coordination and critical thinking
Embraces change and continuously identifies opportunities for improvement by
demonstrating a commitment to creativity and innovation
Committed to promoting excellence in Customer Service; functions as a team
player
Computer literacy and data analysis skills are required
Maintains professional image by demonstrating strong verbal and written
communication skills
Demonstrates ability in self-starting, self-directing and clear
decision-making behaviors

Position Summary:
Works in collaboration with the physician and interdisciplinary team to support
the underlying objective of enhancing the quality of clinical outcomes and
patient satisfaction while managing the cost of care and providing timely and
accurate information to payers. The role integrates and coordinates utilization
management and denial prevention by focusing on identifying and removing
unnecessary and redundant care and promoting clinical best practice. Ensuring
all patients receive the right care, the right cost, right time, and in the
right setting.



Salary Range: $24.00 – $37.87