RN Utilization Review remote - MediGold Health Plan

Lensa - Columbus, OH

Job Title: RN Utilization Review remote - MediGold Health Plan

Position: Registered Nurse

Job Type: Full time

Pay:

Shift:

Work Type:

Location

Address:

City: Columbus

State: OH

ZIP Code:

Job Responsibilities

Participates in designated committees and task forces according to the UM Program and at the direction of the Sr. Director of Medical Management.
Coordinates with the utilization review, case management, and discharge planning staff within network facilities.
Coordinates with Medical Director/Associate Medical Directors on case-specific issues.
Coordinates with Claims, Member Services, Grievance Coordinator, and other operational departments regarding case management issues.
Documents and communicates to QM staff appropriately all identified quality concerns related to Members.
All other duties as assigned.

Required Skills

Core Skills

Ability to analyze, summarize and concisely report medical utilization and medical chart audit results.
Ability to compare approved criteria with clinical information to determine appropriateness of service.
Documentation skills according to department policies and procedures.

Preferred Skills

Nursing experience in an HMO insurance setting.

Requirements

Experience: Minimum of 5-7 years of clinical nursing experience with at least 2 years experience in utilization review or case management.

Education: Associate or Bachelor's Degree in Nursing

License & Certification:

Current license to practice as a Registered Nurse in their home state or hold a compact nursing license.

Schedule:

COVID-19 Requirements: Not Specified

Benefits

Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
Retirement savings account with employer match starting on day one.
Generous paid time off programs.
Employee recognition programs.
Tuition/professional development reimbursement starting on day one.
Relocation assistance (geographic and position restrictions apply).
Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
Employee Referral Rewards program.
DailyPay option for eligible colleagues.

Supplemental Pay

Not specified

Special Notes

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Our Commitment to Diversity and Inclusion: Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states, serving diverse populations.

Facility Details

Name: Lensa

Description: MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States.

Specialties: