Clinical Services Review Nurse Job at MotivHealth, South Jordan, UT

L0JwRHJ4VVdvQXNSYnlVOGVnTmFER1R5V0E9PQ==
  • MotivHealth
  • South Jordan, UT

Job Description

Overview: The Clinical Services Review Nurse position works directly with MotivHealth’s Medical Director to perform Utilization Management (UM) and Case Management (CM) functions.

Responsibilities and Duties

  • Performs clinical intake and reviews cases according to policies and procedures of MotivHealth
  • Collects and enters confidential information ensuring the highest level of confidentiality in all areas
  • Reviews clinical information against MotivHealth criteria and follows appropriate workflow
  • Maintains written documentation according to MotivHealth’s documentation policy
  • Provides quality customer service through interaction with members, providers, administrative staff, and others.
  • Business focus demonstrates an understanding of the company’s vision, mission, and strategy
  • Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others
  • Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs
  • Collaborates with Human Resources to ensure adherence to company policies
  • Performs other related duties and projects as assigned

Qualifications

  • Graduate of an accredited school of nursing
  • Current active unrestricted RN license in a state or territory of the U.S.
  • Five years of prior experience in direct clinical care or managed care setting required
  • Excellent interpersonal, written and presentation skills, including the ability to handle interactions with facility personnel, providers, members, and various internal departments in a professional manner
  • Ability to work in a fast-paced, evolving environment, on-call after hours work may be required
  • Ability to utilize critical thinking skills
  • Strong interpersonal and communication skills
  • Highly motivated, self-starter who works independently using all available resources, policies, and procedures to work effectively and meet required timelines
  • Minimum of 2 years of health care or health plan experience
  • Knowledge of Microsoft Office and programs including Outlook, PowerPoint, Excel, and Word
  • Easily able to adapt to change in a fast-growing company

Job Tags

Similar Jobs

Family Life Academy Charter Schools

Middle School 6th Grade Social Studies Teacher 2024-2025 Job at Family Life Academy Charter Schools

Family Life Academy Charter School (commonly called FLACS) is a network of high-performing charter schools in the South Bronx. Family Life Academy Charter Schools, together with the Latino Pastoral Action Center and parents, create the conditions for self-empowerment for...

Confidential Jobs

Administrative Assistant (Bilingual Korean) Job at Confidential Jobs

 ...Admin Assistant (Korean) - Orange County, CA The ideal candidate will exhibit high standards, excellent communication skills in English and Korean, and have an ability to take initiative, and prioritize daily tasks. A strong ability to take charge and meet tight deadlines... 

Roc360

Post-Closing Document Specialist Job at Roc360

 ...COMPANY BACKGROUND Roc360 is a financial services and asset management platform for residential property investors in the United States. The company connects fragmented loan markets with institutional capital through a branchless network of third-party originators, brokers... 

Pride Health

Progressive Care Nurse Job at Pride Health

Auto Offer Pride Health (TJC Certified) is looking RN Stepdown (PCU) to support one of our largest healthcare clients in New York, NY . Duration: 13 Weeks Shift: Night shift, 7:00 pm- 7:30am + EOW & Holidays On Call: No Pay Range: $2000 -...

Insight Global

Structural Designer Job at Insight Global

Role Tesla is looking for a highly skilled, highly motivated Structural Designer to be part of the North American R&D, Factory and Refinery Infrastructure to help create and optimize the factory of the future by bringing conceptual designs to life, producing innovative...