5 Utilization Review RN Care Manager II Jobs in Indianapolis, IN
Professional Management Enterprises is Hiring a Remote Utilization Review RN Care Manager II
A Medical RN Care Manager II is needed to meet HBR targets and member enrollment. Fully remote M-F 8AM - 5PM. MUST reside in the state of Indiana.
- Cold call outreach to members,
- Completion of member multiple enrollment and follow-up assessments,
- Creation of member care plans
- Input documentation into multiple computer systems
- Daily collaboration with CM/UM/Pharmacy peers to meet member needs
- Checking eligibility in FSSA system,
- Research claim encounter and Hospital systems to obtain member health history
- Maintain Case Load 50
- Daily outreach 20-40 calls daily
- Monthly Quality Audit score 90%
Education/Experience:
Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2 years of clinical nursing experience in a clinical, acute care, or community setting and 1 years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
Licenses/Certifications: Current state’s RN license.
Job Summary
Full Time
Business Services
$64k-81k (estimate)
03/25/2024
05/09/2024
pme-indy.com
INDIANAPOLIS, IN
200 - 500
2005
HASKELL PORTEE
$10M - $50M
Business Services
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About Professional Management Enterprises
PME is a Minority and Service Disabled Veteran Owned Business founded in 2006, that is a highly valued teaming partner in multiple states to large corporations such as Humana, KPMG, Ernst and Young, Anthem, and HP to name a few. Additionally, we provide services in the areas of healthcare, IT, and professional services to Department of Defense and other Federal Government clients. We also are highly engaged in state work in our home state of Indiana, as well as multiple other states nationwide. We successfully leverage our abilities in Healthcare, Managed Care, IT, and Human Capital Services w...ith our flexibility and robust performance.
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