UM Clinical Reviewer

Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

One of the fastest growing Managed Long-Term Care company in New York, Centers Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience.

The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical necessity to ensure all care services, member education, and preventative interventions are maintained.

Qualifications:

• Active RN license, entry level RN welcome

• Excellent written and verbal communication skills

• Ability to meet tight deadlines

• Strong problem solving skills

• Proficient in the use of Microsoft office Suite tools

Who We Are: Centers Plan for Healthy Living’s fundamental mission is to enroll eligible individuals who are either Medicaid or Medicaid/Medicare recipients and optimize their ability to remain in the community rather than being institutionalized. Centers Plan for Healthy Living will accomplish this using a multi-pronged approach to care management including ongoing assessment of members’ care/social needs, developing a “living care plan” that is modified as needed, working with community providers as well as the members and their families/care decision makers. We view the member-centric care team as the collective of providers of care, care decision-makers and Centers Plan for Healthy Living care managers and believe that coordinating high quality clinical and social services will result in better clinical outcomes and independent living for the member.

Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.

Job Details

Pay Type Salary