Job summary
Job post source
This job is directly from Community Care Plan
Job overview
The Utilization Management Nurse plays a crucial role in overseeing service authorization requests and ensuring appropriate utilization of healthcare services, contributing to patient safety and satisfaction.
Responsibilities and impact
Daily responsibilities include reviewing prior authorization requests, maintaining compliance with guidelines, coordinating with medical staff, and promoting optimal resource utilization while ensuring quality improvement.
Experience and skills
Candidates must have a current Florida RN or LPN license, at least two years of utilization review or case management experience, and knowledge of relevant healthcare guidelines and software.
Work environment and culture
The company promotes a diverse and inclusive culture, emphasizing teamwork and collaboration within a hybrid work environment.
Company information
Community Care Plan is dedicated to providing healthcare services, focusing on quality and patient-centered care, while adhering to regulatory guidelines.
Job location and travel
The position follows a hybrid work schedule, allowing employees to work from home three days a week and report to the office two days a week.
Company overview
Community Care Plan (CCP) is a health maintenance organization (HMO) based in South Florida, providing managed care services to Medicaid and other government-sponsored programs. They generate revenue through capitation payments, where they receive a set amount per enrolled member from the government to cover healthcare costs. Established in 2000, CCP was formed as a partnership between Broward Health and Memorial Healthcare System, aiming to improve access to quality healthcare for underserved populations. They focus on preventive care, chronic disease management, and member education to enhance overall community health.
How to land this job
Tailor your resume to highlight your experience in utilization review and case management, emphasizing your knowledge of InterQual and Milliman Criteria as well as your understanding of federal and state guidelines.
Showcase your superior clinical skills and critical thinking abilities, as these are essential for making medical necessity determinations and managing complex cases effectively.
Apply through multiple channels, including Community Care Plan's corporate site and LinkedIn, to maximize your chances of being noticed for this position.
Connect with professionals in the Medical Management division at Community Care Plan on LinkedIn to gain insights about the role and express your interest in the position.
Potential ice breakers could include discussing recent trends in utilization management or asking about their experiences with specific cases or protocols.
Optimize your resume for ATS systems by incorporating keywords such as 'utilization review,' 'case management,' and 'medical necessity' to improve your chances of passing initial screenings.
Jennie Johnson's Power Apply feature can assist you in tailoring your resume, identifying the best application channels, and connecting with relevant professionals, allowing you to focus on other aspects of your job search.
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