- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
- Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
- Identifies members who may benefit from care management programs and facilitates referral
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
- 3+ years of clinical practice experience in an inpatient setting required
- 2+ years of experience as a RN with active unrestricted LA or compact state licensure.
- Must have the ability to obtain additional state licenses as needed.
- Must have the ability to work a schedule with rotating weekend on-call coverage.
- 1+ year of Utilization Management and/or Discharge Planning experience
- Managed care/utilization review experience preferred
- Discharge planning experience preferred
- Associate’s degree required, BSN preferred
Vacancy Type: Full Time
Job Location: Baton Rouge, LA, US
Application Deadline: N/A