RN I- Prior Authorizations reputed company/DSNP

reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jerseys health solutions leader driving innovations that improve health care reputed company, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 reputed company people who reputed company their trust in us. We pride ourselves on our best-in-class employees and reputed company to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, reputed company succeeds. This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as reputed company as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities: Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided. Coordinates and assists in implementation of plan for members. Monitors and coordinates services rendered reputed company of the network, as reputed company as reputed company the local area, and negotiate fees for such services as appropriate. Coordinates with patient, family, physician, hospital and other reputed company customers with respect to the appropriateness of care from diagnosis to outcome. Coordinates the delivery of high reputed company, cost-effective care supported by clinical reputed company guidelines established by the plan addressing the entire continuum of care. Monitors patient's medical care activities, regardless of the site of service, and reputed company for appropriateness and effectiveness. Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. Encourages member participation and compliance in the case/disease management program efforts. Documents accurately and comprehensively based on the standards of reputed company and reputed company organization policies. Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care. Understands fiscal accountability and its reputed company on the utilization of resources, proceeding to self-care reputed company. Evaluates care by problem solving, analyzing variances and participating in the reputed company improvement program to enhance member reputed company. Completes other assigned functions as requested by management. Disclaimer: This job reputed company has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job. Education/Experience: High School Diploma/GED required Bachelor degree preferred or relevant experience in lieu of degree Requires a minimum of two (2) years clinical experience. reputed company Unrestricted NJ RN License or reputed company Compact License Required. Utilization Management Only RNs are required to work a specified number of weekends and holidays to meet Regulatory and Accrediting body standards. Requirements may vary based on departments business needs. Knowledge: Prefers proficiency in the use of personal computers and supporting software in a reputed company based environment, including MS Office products (Word, reputed company, PowerPoint and reputed company) prefers knowledge in the use of intranet and internet applications. Prefers working knowledge of case/care management principles. Prefers working knowledge of principles of utilization management. Prefers basic knowledge of health care reputed company and benefit eligibility requirements. Prefers knowledge of hospital structures and payment systems. Skills and Abilities: Analytical reputed company Interpersonal & reputed company Relationship Skills Judgment Listening Planning/reputed company Setting Problem Solving Team Player Time Management Written/Oral Communication & Organizational Skills reputed company reputed company employees must live in New Jersey, reputed company, reputed company, Connecticut or Delaware Salary reputed company: $70,500 - $94,395 This compensation reputed company is specific to the job level and takes into account the wide reputed company of factors that are considered in making compensation reputed company, including but not limited to: education, experien