Insurance Managed Care RN - UR/CM, Precedence, Inc. - Remote With Insurance Experience
About the position
The Managed Care RN - Case Manager at UnityPoint Health is responsible for coordinating care for patients, managing utilization, and supporting patients through their healthcare journey. This role involves collaboration with interdisciplinary teams to ensure timely and appropriate care, handling payment authorizations, and facilitating community resources for patients. The position is remote or hybrid, offering a full-time schedule from Monday to Friday.
Responsibilities
Perform utilization and case management reviews using established criteria to confirm medical necessity, appropriate level of care, and efficient use of resources and payment approval.
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Request reviews with physician advisors or Executive Health Resources (EHR) if admission or continued stay criteria are not met, ensuring appropriate and timely level of care status.
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Conduct payment authorizations and coordinate payment denials while meeting timeliness guidelines.
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Ensure case coordination with client's health care providers.
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Provide utilization management and case management to designated enrollees, ensuring all enrollees receive clinically sound triage/referral and ongoing care management services for medical needs.
Requirements
Registered Nurse with a Compact Nursing License or licensed behavioral health clinician.
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5+ years of nursing experience.
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Insurance experience on the company side is required.
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CCM (Certified Case Manager) certification.
Nice-to-haves
Professional communication skills, both written and verbal.
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Customer/patient focused approach.
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Self-motivated with the ability to manage priorities and deadlines.
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Flexibility to adapt to changing priorities or needs.
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Planning and organizing skills.
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Proficiency in MS Office (Outlook, Word).
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Ability to give work direction to non-clinical staff.
Benefits
Competitive Total Rewards program with benefits options that align with employee needs and priorities.
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Commitment to diversity, equity, and inclusion in the workplace.
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Support and development opportunities for career growth.
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Community involvement initiatives.
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