Utilization Management Nurse - Remote

Overview

ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns positively impacting maternal and infant health outcomes across America. Our program builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to caregivers at home and throughout the first year of life. We help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.

In Short

• Clinical care (UM) nurses coordinate overall member care.
• Serve as a nurse reviewer for admissions and discharge planning.
• Act as a liaison between providers, hospitals, and health plans.
• Implement client-specific contracted policies and managed care policies.
• Identify and refer potential quality of care issues.
• Document all activities in the electronic medical record.
• May include evening and/or weekend on call.

Requirements

• Registered Nurse (RN) with a current, unrestricted license.
• Three or more years of clinical experience in a Level III or IV NICU.
• Experience in concurrent review or discharge planning is preferred.
• Willingness to provide weekend and holiday coverage.
• Experience with Interqual and/or MCG is preferred.
• Strong computer skills and data entry experience required.
• Excellent interpersonal skills and commitment to customer service.

Benefits

• Paid Time Off
• Paid Parental Leave
• Medical, dental, vision benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• Professional development opportunities
• Business Casual work environment