Utilization Management RN Nurse - Remote

KNOWLEDGE, SKILLS, ABILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Two (2) years managed care experience in UM/CM Department, preferred Knowledge of CMS, State Regulations, URAC and NCQA guidelines preferred ICD-9 and CPT coding experience a plus Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus Experience in EZ-CAP preferred Medical Terminology preferred Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE: Include minimum education, technical training, and/or experience preferred to perform the job. Minimum Education: RN Preferred Education: BA or BS in Nursing Minimum Experience: 3 to 5 years of acute care experience 2 Years Health Plan Utilization Review or equivalent Preferred Experience: 5 years Health Plan Utilization Review 5 years Acute Care experience with 1 year ICU / ER REQUIRED CERTIFICATIONS/LICENSURE: Include minimum certification required to perform the job. Licensure must be current and unrestricted in the appropriate jurisdiction PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Must be able to work in sitting position, use computer and answer telephone Ability to travel Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Office Work Environment TRAVEL: Approximately 5% travel may be required

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