Vacancy caducado!
Job Description:SelectHealth is a not-for-profit community health plan serving more than 1 million members in the intermountain west that offers a variety of Medicare, Medicaid, Marketplace Qualified Health Plans and commercial health plans. Utilization review behavior health professional proactively manage inpatient and outpatient utilization to assure that medical care is appropriate, efficient, and medically necessary.Posting Specifics:Benefits Eligible: YesShift Details: Full time, 40 hours, 5 days/week. One day to possibly include weekend in rotation or normal shift. More discussion in interview!Unit/Location: Nevada Central Office – hybrid work schedule after trainingBenefits:We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .Minimum Qualifications
Current RN license in state of practice.
Three years clinical nursing experience.
One year in Managed Care, Utilization Management, or Case Management.
Basic computer skills including word processing and spread sheets.
Excellent organizational, written, and interpersonal skills and the ability to anticipate and solve problems and communicate clearly and effectively.
RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion.
Preferred Qualifications
Bachelor's degree in Nursing (BSN). Education must be obtained from an accredited institution. Degree will be verified.
Current working knowledge of Medicare, Medicaid and Commercial insurance.
Current working knowledge of utilization management and case management techniques.
Working understanding of coding or utilization management criteria (i.e., InterQual, CMS manual).
Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.
Job duties include:
Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.
Applies evidence-based guidelines (e.g. InterQual) and medical policies with prior authorization and concurrent reviews and follows the applicable regulatory guidelines (NCQA, CMS) to provide clear and timely communication to members and requesting providers
Identifies members for referral opportunities to integrate with other products, services and/or programs
Physical Requirements:Ongoing need for employee to see and read information, assess member needs and view computer monitors.
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Frequent interactions with providers, members that require employee to verbally communicate as well as her and understand spoken information, needs and issues accurately.Anticipated job posting close date:03/07/2024Location:Nevada Central OfficeWork City:Las VegasWork State:NevadaScheduled Weekly Hours:40The hourly range for this position is listed below. Actual hourly rate dependent upon experience.$38.83 - $57.46We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.Intermountain Health is a Utah-based, not-for-profit system of 33 hospitals (includes "virtual" hospital), a Medical Group with more than 3,800 physicians and advanced practice clinicians at about 385 clinics, a health plans division called SelectHealth, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.To find out more about us, head to our career site here (https://intermountainhealthcare.org/careers/?utmsource=Workday&utmmedium=Redirect&utmcampaign=CareerHomeworkday) .Sign up for job alerts! Click ‘sign in’ at the top right corner, create a candidate account, and when we have opportunities that meet your interests, you will receive an email with the job details.Intermountain Health strives to make the application process accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 1-800-843-7820 or email [email protected] . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.We intentionally work toward an Intermountain Health that reflects our diverse communities and provides culturally competent care, health equity, and a sense of belonging amongst all our caregivers (employees). This is an important part of fulfilling our mission to help people live the healthiest lives possible. The three pillars of our work are talent experience with Intermountain (application, internship, development, etc.), community benefit, and care delivery.Learn more about diversity at Intermountain, here. (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/)Introduce yourself to our Talent Acquisition team and we will get in touch if there is a role that seems like a good match.Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/peak-program/)The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.All positions subject to close without notice.Thanks for your interest in continuing your career with our team!
Vacancy caducado!