Registered Nurse / Case Manager / Utilization Management

Who Are We? Health Design Plus is a privately held, medical Third Party Administrator. We serve larger employers & organizations who engage us to provide data-driven, consultative & strategic approaches to managing their health benefit plans & medical trend. HDP partners with its clients in order to achieve the clients' goals in the areas of quality, employee health, & cost effectiveness.

The Role

HDP offers you the opportunity to utilize your clinical skills and judgment to determine medical necessity, based on established criteria, and to facilitate/coordinate services for client specific patients who are receiving care in acute inpatient, skilled long-term care facility, and/or outpatient settings. You will be working with a team of dedicated professionals in a collaborative environment.

Key Responsibilities Conduct prospective, concurrent, & retrospective reviews to determine the medical necessity of inpatient admissions & outpatient services

Determine the medical appropriateness for benefits of health services or treatment settings based on information received from providers or plan members

Guide the setting for medical intervention to achieve optimum length of stay and early identification of continuing care needs to facilitate discharge planning to the appropriate setting and/or referral to other Care Management programs

Actively participate in client (employer) meetings which include the presentation of aggregate outcome reports

Qualifications

Must be a Registered Nurse, in good standing, with an active state license Strong clinical background with a minimum of three years recent acute care experience

Previous managed care experience desirable

Effective written and oral communication skills are a must -- all communications with patients & providers are either telephonic or electronic

Must be well organized and able to multi-task Must have strong computer skills & the ability to learn those software products used by HDP (the Care Mgt. system)

Other

Hours: Monday thru Friday, 8:30 AM - 5:00 PM Location

We are conveniently located in Hudson, OH with easy access to major roadways

Interested? Learn more about us by visiting our website at www.hdplus.com. Then, send a cover letter & resume to one of the addresses listed below. (Please use a current version of Word).

We regret that we can only respond to candidates selected for interview. No phone calls please.

EOE M/F/D/V