Utilization Management RN Nurse - Remote

Tenet Healthcare Corporation
Any Location, US
Remote
Job Description
This Utilization Management Nurse role at Conifer Health ensures quality patient care, efficient utilization of services, and appropriate discharge planning. They identify referrals, manage coverage and eligibility, and collaborate with medical and customer service teams to maintain compliance and quality service. This role focuses on both clinical aspects and ensuring the safety of patients.

Requirements

  • Experience managing care in the Utilization and Customer Service Department
  • ICD-9 and CPT coding experience (a plus)
  • Knowledge of CMS, State Regulations, URAC and NCQA guidelines (a plus)
  • Experience with EZ-CAP (preferred)
  • Medical Terminology preferred

Benefits

  • Medical, dental, vision, disability, and life insurance
  • Paid time off
  • 401k with employer match
  • Paid holidays
  • Health savings accounts
  • Employee discount program
  • Voluntary benefits (pet insurance, legal insurance, etc.)
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