Cedar
Cedar is committed to improving the healthcare billing experience for all.
New York, NY
Remote

Utilization Management Registered Nurse

Sorry, this job was removed at 7:43 a.m. (EST) on Tuesday, October 26, 2021
Find out who’s hiring remotely
See all Remote jobs
Easy Apply
By clicking Apply Now you agree to share your profile information with the hiring company.

Cedar is a new, passionate organization founded by top-tier entrepreneurs who are committed to transforming our healthcare system! Cedar is building a ground-breaking technology platform that eliminates unnecessary administration from the billing and payments process, enabling providers to get paid faster and patients to get care more easily and quickly. Founded in 2017 with substantial financial backing, we are a hard-working, thriving team looking for dedicated teammates to make a major impact on the healthcare system. We are committed to living what we value to provide a positive and dynamic working environment for our team members. Based on the principle of Colonel John Boyd’s OODA Loop, we know we must move quickly and with purpose to effect meaningful change in healthcare.

We are looking for a passionate Registered Nurse with a deep understanding of prior authorizations to contribute to our authorization automation product. The successful applicant will be responsible for handling referral/authorization and utilization management activities, suggest potential improvements and/or changes as appropriate, and handle and disposition the Prior Authorization (PA) as may be assigned. This role will also perform day-to-day activities required for PA processing and follow defined business rules and policies, including timeliness requirements. This person ensures their assigned areas are aligned with referral/authorization management policies, procedures, and processes to maintain strict contract requirements and to promote the delivery of high-quality, efficient care. This person collects and analyzes individual data to resolve operational efficiency and effectiveness, and provides feedback, and actively engages with our product teams. In addition, the UM Nurse ensures timely and accurate processing of referrals and authorizations including benefit/medical necessity review, pre-authorization, inpatient current review, discharge planning, and assessment for potential quality issues.

Additionally, you will review prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations.

This role is required to be located in the United States.

Responsibilities:

  • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
  • Collaborate with various staff within provider networks and case management teams electronically or telephonically to coordinate member care
  • Educate providers on utilization and medical management processes
  • Provide clinical knowledge and act as a clinical resource to non-clinical team staff.
  • Enter and maintain pertinent clinical information in various medical management systems

Requirements:

  • Solid understanding of peer review criteria, NCQA, CMS, and other regulatory and accreditation requirements
  • Has done medical record reviews before and used software to enter their findings
  • Hold an active LPN or RN state license.
  • Strong understanding of payer medical policies
  • Experience reading clinical documentation to identify/extract service requirements, such as age, comorbidities, medical history, etc.
  • Understanding of the Utilization Management process
  • Excellent digital literacy, including the ability to quickly learn multiple web and desktop-based tools. The end-user experience on these tools will change frequently- candidates will be encouraged to adapt quickly while maintaining high quality and through out standards
See More
Easy Apply
By clicking Apply Now you agree to share your profile information with the hiring company.

What are Cedar Perks + Benefits

Cedar Benefits Overview

Working at Cedar: what’s not to love?

Being part of our team means working together to solve a problem that impacts millions of consumers every year. It’s challenging, exciting and complex. We’re proud to be the only company that truly empowers consumers with an easier, more personalized and transparent healthcare journey.

Culture
Volunteer in local community
Open door policy
OKR operational model
Team based strategic planning
Pair programming
Open office floor plan
Employee resource groups
Employee-led culture committees
Hybrid work model
In-person all-hands meetings
Employee awards
Flexible work schedule
Remote work program
Cedar offers a very flexible remote work program, both pre-COVID and after.
Diversity
Documented equal pay policy
Mandated unconscious bias training
We offer annual unconscious bias training for all employees.
Diversity employee resource groups
Hiring practices that promote diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Disability insurance
Dental insurance
Dental benefits are part of our comprehensive benefits offered through industry brand carriers with multiple options to choose from.
Vision insurance
Vision benefits are part of our comprehensive benefits offered through industry brand carriers with multiple options to choose from.
Health insurance
Life insurance
Pet insurance
Mental health benefits
We offer an experienced EAP counselor 24 hours a day, 7 days per week.
Financial & Retirement
401(K)
Company equity
Child Care & Parental Leave Benefits
Generous parental leave
At Cedar we want to support all new parents in their expanding family. Therefore, we offer our full time team members who are expecting or having a new child Paid Leave.
Family medical leave
Cedar offers family medical leave for employees. Our leave partner walks employees through every step of the process.
Vacation & Time Off Benefits
Unlimited vacation policy
Paid holidays
Paid sick days
Company-wide vacation
Cedar offers company wide shut downs around major holidays
Office Perks
Commuter benefits
Cedar offers pre-tax commuter benefits for all full-time employees.
Company-sponsored outings
Free daily meals
Daily lunches are provided at our NYC HQ.
Free snacks and drinks
Our kitchen is stocked full of snacks and drinks for every desire! Some of our favorites are cold brew, kombucha, rotating craft beers, fresh fruit, yogurt and every kind of chip you can imagine!
Company-sponsored happy hours
Pet friendly
Our NYC HQ has a dog lounge. Bring your dog to work!
Meditation space
Mother's room
Professional Development Benefits
Job training & conferences
Lunch and learns
Cedar hosts lunch & learns monthly. This allows employees to present in-depth on projects they're working on or for the occasional guest invitee to teach the team about a topic of interest.
Promote from within
Mentorship program
Our mentorship program pairs folks based on shared interests and goals, from the same team or cross-functionally, and emphasizes building mutually beneficial relationships for professional equity.
Customized development tracks
Paid industry certifications
Personal development training

Additional Perks + Benefits

We take great pride in making our employees' wellness a top priority, and we create opportunities to talk openly about mental health and wellbeing.

We have a directory with resources for mental and physical wellbeing, emphasizing benefits offered through our health insurance. The directory covers topics such as managing grief, therapist information, nutrition & water intake, and resources on talking to children about current events. We want to take a holistic approach and include resources that appeal to everyone, so we also included information on remote alternative wellness offerings, including reiki, sound healing, meditation and yoga. We even have an onsite meditation room in our NYC HQ!

More Jobs at Cedar

Easy Apply
By clicking Apply Now you agree to share your profile information with the hiring company.
Learn more about CedarFind similar jobs like this