Top 4 Utilization review nurse Jobs in Manitowoc, Wi

Five Star Nurse Navigator (full-time hourly / remote / hybrid)
Prairie States Enterprises, Inc. —Sheboygan, WI
- Extended hours
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
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Five Star Nurse Navigator (full-time hourly / remote / hybrid)
Prairie States Enterprises, Inc. —Sheboygan, WI
Ability to manage an independent case load. Computer Skills: Word, Excel, Microsoft Outlook, keyboarding and data entry. Ideal candidate will work in Wisconsin.
Quick Apply

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Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
10d
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
10d

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Five Star Nurse Navigator (full-time hourly / remote / hybrid)

Prairie States Enterprises, Inc.
Sheboygan, WI

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Job Details

Full-time

Benefits

Disability insurance
Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
401(k) matching

Qualifications

Microsoft Excel
HIPAA compliance
Microsoft Outlook
Phone communication
HIPAA
Change management
Clinical interprofessional collaboration
Typing
Managing patients as a clinical case manager
Hospital experience
Quality data entry
Client interaction via phone calls
Customer data entry

Full Job Description

FIVE STAR NURSE NAVIGATOR (FULL-TIME / REMOTE / HYBRID)

This is a full-time position with a hybrid remote work arrangement in our Sheboygan, WI location. No weekends, holidays or on-call rotations. Ideal candidate will work in Wisconsin.

Prairie States Enterprises, Inc. is a third party administrator, a benefits industry leader, and a trusted advisor to self-insured companies and their employees. We provide a complete range of medical benefit management services, all performed in-house, and to exacting standards of excellence.

JOB SUMMARY

The role of the Five Star Nurse Coordinator is to provide a clinically enhanced member experience beginning with the initial phone call through the completion of service or reason for the contact. Five Star Nurse Coordinators function as part of a team from the customer service perspective. The Five Star Nurse Coordinator will also navigate members to high value providers based on direct contracts and episodes of care within a network. The coordinator is also responsible for internal referrals to other services at PSE, transfers to internal and external health plan related services as needed, and pro-active efforts with regard to promoting preventive screens and adherence to national guidelines for a variety of common chronic conditions. Five Star Nurse Coordinators serve in both an ‘inbound’ and ‘outbound’ role with regard to member relations.

Extended service hours are part of the Five Star service model.

SUMMARY OF ESSENTIAL JOB FUNCTIONS

Member navigation to high value providers based on member’s needs for services within the available direct contracts or bundles/episodes of care.
Work collaboratively with FiveStar Navigators and nurses on clinical member needs as assigned.
Documentation of interactions and guidance provided to members.
Work with customer clinics/DPCs on care navigation needs
Work with contracting entities as needed
Coordinate weekly meetings with vendor partners and internal FiveStar and nursing teams to ensure collaboration on member needs.
Create out of area student plan with regard to network access
Coordinate with second opinion entities and programs as needed.
Provide member education
Internal referrals to pre-cert, UM, CM, DM and Optimal Health as needed based on member needs.
Coordinating care or services as needed
Other duties as requested or assigned

POSITION REQUIREMENTS

Education –LPN or ADN required with current licensure in good standing
Effective communication skills including oral, nonverbal and written
Ability to work collaboratively with the Health Services team and other PSE departments
Ability to manage an independent case load
Strong organizational skills
Strong sense of customer service
Ability to work with diverse individuals
Adherence to and application of HIPAA regulations
Experience – 3 years in a clinical or hospital setting.
Computer Skills: Word, Excel, Microsoft Outlook, keyboarding and data entry
Experience in utilization review, concurrent review and /or discharge planning
Telephone etiquette
Must be able to carry on conversations with medical providers, and members to facilitate good understanding by all parties

REQUIRED COMPETENCIES

Change Management – Accepts, supports, and executes assignments in conditions of change which support attaining department goals.
Effective Communication – Demonstrates effective and responsive communications following the appropriate reporting structure.
Accountability/Results – Achieves and/or exceeds result based goals that were specific, measurable, and timely.
Teamwork – Demonstrates teamwork behaviors and makes positive contributions and which support the achievement of department goals.
Customer Satisfaction – Dedicated to the PSE service model and meets or exceeds PSE customer satisfaction expectations in providing exemplary service.
Professional Growth – Takes ownership of one’s professional growth within one’s current position and to advancement at PSE.

PHYSICAL DEMANDS / WORK ENVIRONMENT
This is sedentary position which requires the individual to sit for long periods of time and the proper positioning/posturing for extensive viewing of computer screens and computer related work is required. It is encouraged that individuals intermix this sedentary time with periodic movement within one’s office space and/or to other office areas to counteract the sedentary nature of this position.

To the selected candidate, we offer:
Competitive compensation based on experience and a comprehensive benefit package provided to include Medical, Dental, Vision, Life, STD/LTD, FSA, Paid Time Off, 401k with match, wellness and exercise membership and more. Click HERE to view our full-time benefits flyer.

Opportunity for meaningful career growth within a results-driven company and our company culture is one of ambition, integrity, empowerment, teamwork and a passion for personal and company success.

If this sounds like you and you’re seeking career growth with an exciting new career path in overseeing the quality of health care for our clients and their members, please send your cover letter and resume following the instructions for this site.

Prairie States Enterprises
Equal Opportunity Employer

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utilization review nurse jobs in manitowoc, wi

Five Star Nurse Navigator (full-time hourly / remote / hybrid)

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