RN UM Clinical Reviewer Senior Analyst - Work from Home, Anywhere, USA

* Job Description Summary

Provides advanced professional input to complex Nurse Case Management assignments/projects.

Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.

Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves.

Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.

Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.

Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.

May review initial liability disability claims to determine extent and impact of insured's medical condition, medical restrictions and limitations and expected duration.

Performs leadership role on team when implementing new tools or case management programs/initiatives.

Manages own caseload and coordinates all assigned cases.

Supports and provides direction to more junior professionals.

Works autonomously, only requiring "expert" level technical support from others.

Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.

Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management.

RN and current unrestricted nursing license required.

Hiring Requirements

Job Details



* Job Profile
Job Profile

+ UM Clinical Reviewer Senior Analyst


* Job Families for Job Profiles
Job Families for Job Profiles

+ Medical Management--Utilization Mgmt.


* Worker Sub-Type
Worker Sub-Type

+ Regular


* Worker Type
Worker Type

+ Employee


* Time Type
Time Type

+ Full time


* Compensation Grade
Compensation Grade

+ S03406


* Remote Type
Remote Type

+ Remote


* Primary Location
Primary Location

+

Arizona Work at Home


* Primary Job Posting Location
Primary Job Posting Location

+

Colorado Work at Home


* Additional Locations
Additional Locations

(empty)


* Additional Job Posting Locations
Additional Job Posting Locations

(empty)


* Scheduled Weekly Hours
Scheduled Weekly Hours

40


* Work Shift
Work Shift

+ OMD Timekeeping (United States of America)


* Recruiting Start Date
Recruiting Start Date

02/06/2025


* Target Hire Date
Target Hire Date

02/06/2025


* Target End Date
Target End Date

(empty)

Additional Information



* Union Membership from Job Profile
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