About Us Healing Body and Mind. NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. Our hospitals use an interdisciplinary, multi-specialty approach that delivers high-quality, patient-centered care when it’s needed most. With locations in Indiana, Michigan, Texas, and Arizona, we’re expanding access to our unique model of care across the United States. Join us and be part of a team dedicated to making a lasting difference in the lives of patients and families every day Overview Neuropsychiatric Hospitals is looking for a Utilization Review Nurse (RN) to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams. This position will support multiple hospitals both remotely and traveling onsite to the hospitals. Location: REMOTE- We are looking for someone located in the Midwest area, with strong preference in Indiana, Michigan, or Ohio. Benefits of joining NPH - Competitive pay rates - Medical, Dental, and Vision Insurance - NPH 401(k) plan with up to 4% Company match - Employee Assistance Program (EAP) Programs - Generous PTO and Time Off Policy - Special tuition offers through Capella University - Work/life balance with great professional growth opportunities - Employee Discounts through LifeMart Responsibilities - Coordinate and support the hospital’s Utilization Review and Case Management program to ensure appropriate level of care, efficient resource use, and timely discharge planning. - Review patient charts and clinical documentation to verify medical necessity, severity of illness, and compliance with regulatory and care guideline standards (InterQual and Milliman). - Conduct admission, concurrent, and length-of-stay reviews and communicate with payors regarding precertification, concurrent reviews, and authorizations. - Collaborate with physicians, nursing staff, medical records, and finance to ensure accurate documentation and appropriate reimbursement. - Monitor patient progress and coordinate care management strategies to support positive patient outcomes and reduce unnecessary length of stay. - Identify utilization trends or documentation gaps and recommend process improvements to enhance quality and financial outcomes. - Participate in multidisciplinary care coordination meetings and communicate with internal teams, families, and external providers as needed. - Prepare reports and maintain documentation related to utilization review, denial management, and regulatory compliance. - Maintain knowledge of current regulatory, accreditation, and reimbursement requirements related to utilization management and case management. Qualifications - Education: High School Diploma or GED and graduate from an accredited LPN program or Associate Degree in Nursing required. Bachelor or Masters of Science in Nursing or Behavioral Health field preferred. - Experience: Minimum of 4 years of utilization review experience in a hospital setting required. Minimum of 2 years of case management experience, including discharge planning in a hospital setting preferred.. - Licensure: Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the state of practice required. Certified Case Manager (CCM), or Accredited Case Manager (ACM) preferred. - Ability to work independently and collaboratively within a multidisciplinary team environment. - Strong organizational and time management skills with the ability to prioritize tasks and manage a changing workload. - Ability to analyze patient care data, develop criteria, and apply patient care methodologies. - Experience abstracting and presenting data in a clear, professional manner for medical committees or leadership. - Strong attention to detail with accurate documentation and data entry skills. - Ability to maintain strict confidentiality and protect patient privacy. - Ability to build and maintain effective working relationships with physicians, clinical staff, medical records personnel, social workers, patients, and the public. - Strong communication skills, both written and verbal, including the ability to explain clinical and case management information to patients, families, and healthcare providers. - Knowledge of care management plans, critical pathways, and case management practices. - Knowledge of healthcare regulations and accreditation standards, including Case Management, Utilization Management, Risk Management, and HFAP/JCAHO requirements. - Familiarity with hospital policies, medical staff bylaws, and community resources. - Proficiency with Microsoft Office applications, email, and computer systems. - Strong problem-solving and basic research skills. - Knowledge of medications and patient care management practices. - Travel flexibility up to 50–70% as required.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. *Must be licensed in California Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. - Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care - Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member - Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered - Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines - Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings - Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members - Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines - Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities - Collaborates with care management on referral of members as appropriate - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: - For Health Net of California: RN license required - **Must be licensed in California Location: Position is remote. Hours: 8:00-5:00 PST. Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance RN Field Case Manager This Field Case Manger will cover our Raleigh, NC region and must live in this area in order to be considered. Must be and RN and have as least 1.5 years of prior Field Case Manager workers compensation experience. PRIMARY PURPOSE OF THE ROLE: Sedgwick Field Case Managers work face to face with their injured workers and medical providers to facilitate; though advocacy, progressive medical treatment, and timely return-to-work; while acting as a liaison and providing communication between all involved parties. While frequent travel is required, you will maintain a home-based office. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. - Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. - Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment that allows face to face interaction with injured workers and medical professionals. - Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. - Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. . ESSENTIAL RESPONSIBLITIES MAY INCLUDE - Serve as patient advocate to support, guide and coordinate care for injured workers, families and caregivers as they navigate through the recovery process. - Assist injured workers in achieving recovery and autonomy through advocacy, communication, education, identification of service resources and service facilitation. - Identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source EDUCATION AND LICENSING RN licensure required. Valid driver’s license required. High speed internet required. TAKING CARE OF YOU BY - Offering a blended work environment. - Supporting meaningful work that promotes critical thinking and problem solving. - Providing on-going learning and professional growth opportunities. - Promoting a strong team environment and a culture of support. - Recognizing your successes and celebrating your achievements. - We offer a diverse and comprehensive benefits package including: - Three Medical, and two dental plans to choose from. - Tuition reimbursement eligible. - 401K plan that matches 50% on every $ you put in up to the first 6% you save. - 4 weeks PTO your first full year. NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch. #nurse #fieldcasemanager Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.