Remote Utilization Management RN Job at Clinical Management Consultants, Mcminnville, OR

  • Clinical Management Consultants
  • Mcminnville, OR

Job Description

A renowned coordinated care facility is actively seeking a Remote Utilization Management RN to join their team. 

The following qualifications are preferred:

  • Medicaid regulatory experience (Oregon Medicaid preferred)
  • Health Plan Utilization Management: experience reviewing for medical necessity using clinical guidelines as a payer / insurance plan
  • Staff supervision and program management experience
  • RN license in the state of Oregon

The Remote Utilization Management RN will play a vital role within this Coordinated Care Organization (CCO). The Utilization Management RN is responsible for overseeing the utilization management process and will lead a team of professionals in reviewing healthcare services, ensuring their medical necessity and appropriateness while complying with regulations and industry standards. This role involves following policies and procedures, monitoring compliance, and analyzing data to improve processes. The Utilization Management Nurse will also communicate with healthcare providers and insurance companies, advocate for patients' rights, and drive continuous improvement initiatives. 

Take this exciting opportunity to join a renowned facility as its Remote Utilization Management RN. This role offers a competitive salary and generous benefits. Apply today to learn more about this opportunity!

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