Utilization Management Nurse 2 - Remote

Overview

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations.

In Short

• Support coordination and documentation of medical services.
• Use clinical knowledge and communication skills.
• Make independent determinations on courses of action.
• Coordinate with providers and members for optimal care.
• Follow established guidelines and procedures.
• Requires minimal direction and guidance.
• Must be a Licensed Registered Nurse (RN) in Florida.
• Prior clinical experience in acute care is preferred.
• Knowledge of Microsoft Office tools is essential.
• Bilingual skills are a plus.

Requirements

• Licensed Registered Nurse (RN) in Florida.
• Prior clinical experience in acute care.
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
• Ability to work independently and in a team.
• BSN or Bachelor's degree in a related field preferred.
• Experience in utilization management preferred.
• Knowledge of MCG (Milliman) Criteria is a plus.
• Health Plan experience is preferred.
• Previous Medicare/Medicaid experience is a plus.
• Puerto Rico RN License is a plus.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including holidays and volunteer time.
• Short-term and long-term disability coverage.
• Life insurance options.