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Role Overview:
- Identify high-risk members and connect them with appropriate care resources.
- Conduct utilization management reviews using established criteria.
- Support accreditation and quality improvement initiatives.
Requirements:
- Current RN license with at least 3 years of clinical experience.
- Experience with Medicare/Medicaid populations and care management preferred.
- Knowledge of InterQual/Milliman guidelines and NCQA standards.
Benefits:
- Full-time remote work within the US.
- Opportunity for professional growth in care coordination and population health.
- Collaborative, mission-driven environment.
Jobgether
They are a health plan focused on improving outcomes for high-risk members through care coordination and quality initiatives. Their team values collaboration, clinical excellence, and mission-driven work to enhance community health.