Allegheny Health Network is hiring a Care Manager RN to implement effective utilization management strategies from a remote position. In this role, you will review the appropriateness of healthcare services, apply criteria to ensure proper resource use, and identify opportunities for case management intervention. You will monitor service delivery, educate providers and members, and analyze data to develop strategies that improve performance and satisfaction.
What You'll Do
- Implement care management review processes consistent with industry and corporate standards.
- Function in accordance with all applicable state, federal laws, and regulatory compliance requirements.
- Conduct all reviews according to accepted, established criteria and approved medical policies.
- Promote quality and efficiency in the delivery of care management services.
- Respect member privacy, sharing only information relevant to care within legal frameworks.
- Practice within the scope of ethical principles.
- Identify and refer members who could benefit from Health Coaching or case management.
- Employ collaborative interventions to maximize member health outcomes.
- Educate professional and facility providers to improve processes and develop network relationships.
- Develop positive working relationships with internal and external customers.
- Utilize outcomes data to improve ongoing care management services.
What We're Looking For
- 3 years of related, progressive clinical experience in your area of specialization.
- Experience working in a clinical setting.
- Current State of PA RN licensure OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Additional state licensure(s) may be required.
Nice to Have
- Bachelor’s Degree in Nursing.
- Experience in UM/CM/QA or Managed Care.
- Medical/Surgical experience.
- Utilization Management (UM) or Utilization Review (UR) experience.
- Certification in utilization management or a related field.
Benefits & Compensation
- Salary range: $50,200.00 - $91,200.00
Work Mode
This is a fully remote position.
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