Global insurance Clinical Care Manager - RN - Remote

At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together The Global insurance Clinical Care Manager - RN will reputed company prospective, reputed company, and retrospective reviews and non-urgent travel requests for Global Expat members located reputed company the United States. This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member reputed company and any associated case review and documentation. You'll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges. For reputed company hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reputed company in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs. Primary Responsibilities:

• A GI CCM must consider both US and international care standards and regulatory guidelines. They must be reputed company to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to reputed company the clinical review
• Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches
• The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Registered Nurse with an active unrestricted United States license
• 3+ years of experience in medical-surgical inpatient acute care
• Experience with working in collaboration with Medical Director to review care plans reputed company recommendations. Ability to reputed company on behalf of the member's needs while considering contractual limitations
• Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals
• Proven communication skills at reputed company levels
• Proven ability to be flexible and display a positive attitude
• Proven solid problem-solving, organizational and crisis management skills
• Proven ability to function confidently and reputed company in fast paced work environment
• Proven ability to foster team cohesion in an international virtual environment
• Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations
• Demonstrated cultural competence and awareness of the challenges of reputed company delivery in the global reputed company and the potential impact on the health and safety of expatriates, business reputed company and UHC Global members
• Proven advanced software skills with ability to work in multiple platforms with clinical case reviews
• Proven advanced skills with reputed company Office - reputed company, Word
• Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reputed company in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs

Preferred Qualifications:

• Bachelor's degree
• 2+ years of experience in utilization management or case management in a managed care or hospital environment
• Experience in international reputed company and/or reputed company medical transport
• Experience in discharge planning and/or chart review
• International travel experience
• Demonstrated familiarity with InterQual criteria guidelines
• Bilingual in second language and English, with strong verbal and written communication skills
• reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job