As a registered nurse, you will work remotely to enhance the quality of member management, maximize satisfaction and cost effectiveness, and assist in navigating the health care system. The RN will work closely with client and members to promote wellness, problem-solve, and assist members in realization of their personal health-care related goals. This role includes telephonic member and provider outreach, data collection, and documentation.
Oversee clinical inpatient UM staff, ensuring they effectively perform utilization management (UM) reviews for inpatient cases. This role works closely with the Care Coordination and Care Management teams, which are distinct pillars, to ensure appropriate utilization reviews and that care is delivered efficiently. Ensure adherence to internal and external policies, regulations, and goals. This role is remote (with a clear and current CA RN license), but will be expected to work PST business hours and will require Admin on-call on weekends/holidays.