Job Description
Job Title: Remote Utilization Review RN Case Manager
Pay: $34.13 an hr | Bi-weekly
Job Type:
Shift Options:
M-F 8-5
Remote Utilization Review RN Case Manager Overview:
Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations.
Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
Data gathering requires navigation through multiple system applications.
Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
Commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.
Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
Condenses complex information into a clear and precise clinical picture while working independently.
Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
Remote Utilization Review RN Case Manager Qualifications:
Remote Utilization Review RN Case Manager Benefits:
How to Apply:
If you are interested in this position, please apply OR submit your resume to:
Saw Hlaing | shlaing@alinestaffing.com | 412-790-5425
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