JOB REQUIREMENTS: RN Case Manager-Utilization Care Management JobLocations US-WI \| US-WI-Waukesha \| US-WI-La Crosse \| US-WI ID2024-2042 Category Clinical Services Type Regular Full-Time Overview Areyou a licensed RN who is interested in using your clinical expertiseoutside of a clinical or hospital setting? Do you pride yourself inexamining all the details of a situation before making importantdecisions? Are you passionate about ensuring that all patients receiveoptimal types and levels of care? If so, please consider joining Quartzas a Utilization Management Registered Nurse (RN) Case Manager. Thisrole is responsible for review of prior authorization requests fortreatment and services coordination of care for patients transitioningback to in-network services, technology assessment, research, andcollaboration with internal and external customers such as primary carephysicians, hospital case managers, home health and skilled nursingfacility staff to achieve optimal patient care. Benefits: First shiftwith regular, full-time hours and no weekends or holidays. Supportiveand experienced team members to assist with training and cases Be a partof a stimulating environment by reviewing referrals for a wide range ofcare services Opportunity to obtain additional learning experiences andengage in growth opportunities Option to work in-person, hybrid, orremote available Compensation pay range: \$72,000 - \$88,000Responsibilities Perform clinical reviews of prior authorizationrequests. Conduct prospective, concurrent, and retrospective medicalreview of members requiring inpatient, SNF and home health services.Coordination of care and treatment plans, and transition of care.Communicate with members, caregivers, and providers for all medicalreviews regarding patients. Accurately document all relevant informationand presents cases to the Medical Director as applicable. Maintainknowledge of all commercial, CMS and DHS clinical guidelines andregulatory requirements. Qualifications Bachelor\'s Degree in nursing orAssociate\'s Degree with combination of relevant, equivalent experience.Unrestricted State of Wisconsin RN license. Additional licensure in IL,MN, or ability to obtain preferred. 2+ years of RN utilizationmanagement experience in a clinical and/or inpatient setting required.Insurance or managed care experience preferred. Valid driver\'s licenserequired. Some travel required within Quartz\'s service area.Exceptional customer service skills. Strong computer skills, includingfamiliarity with UM decision support software and Microsoft Word, Excel.Ability to function well in a diverse environment that includesclinical, financial, business, and regulatory requirements. Thisposition can work 100% remotely or from our office in... For full infofollow application link. Equal Opportunity Employer of Minorities,Females, Protected Veterans, and Individual with Disabilities *****APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/272304252B26496F