RN UM Discharge, Planning

Summary :
Collaborates with other health care providers to evaluate medical necessity of care, for elective and emergency admissions, surgeries, diagnostic procedures and treatments. Coordinate the delivery of services in the most appropriate setting, and provide support for transitions between settings for plan members that meets organizational goals related to quality outcomes, member experience, and cost-efficiency, using approved medical criteria and regulatory guidelines.

Formal Education Required :
a) Bachelor Degree or may substitute with 4 years of like experience.

Experience & Training Required :
a) 3+ years performing same or similar responsibilities. Relevant experience includes: previous industry, utilization management/utilization review experience and care coordination.

Other Skills, Competencies and Qualifications:
a) Registered Nurse (RN) state license in good standing. CCM/ACM certification or equivalent helpful.
b) Basic typing/computer skills needed to collect, assess, and enter data.
c) Demonstrate knowledge and skills necessary to provide care appropriate to the age of the members serviced. Takes ownership in identifying and obtaining education and training needed to meet needs of the members.
d) Work cooperatively with team members to accomplish HSM mission and goals.
e) Organize and manage time to accurately complete tasks within designated time frames in fast paced environment.
f) Maintain current knowledge of and comply with regulatory and company policies & procedures.
g) Maintain confidentiality of member health and business information.
h) Flexible: Ability to adjust work hours to meet business demands.
i) Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity

Level of Physical Demands:
1) Sit and/or stand for prolonged periods of time.
2) Bend, stoop, and stretch.
3) Lift up to 20 pounds.
4) Manual dexterity to operate computer, phone, and standard office machines.