Utilization Management Nurse I - Remote

Overview

As a Utilization Management (UM) Nurse, you will provide UM services, transition of care and support to members and health care providers, utilizing clinical knowledge to interpret medical policy and assist members through the continuum of care.

In Short

• Provide UM services and support to members and health care providers.
• Utilize clinical knowledge to interpret medical policy and criteria.
• Assist members in navigating the continuum of care.
• Collaborate with a multidisciplinary team to improve processes.
• Strong communication skills are essential for success.
• Prior health plan or UM experience preferred.
• Flexible work environment with remote options available.
• Must be organized and detail-oriented.
• Commitment to service excellence and member advocacy.
• Ability to manage multiple priorities in a dynamic environment.

Requirements

• Completion of an accredited nursing program.
• Active RN or LPN license in Iowa or South Dakota.
• 4+ years of diverse clinical experience.
• Strong verbal and written communication skills.
• Ability to work independently and manage a caseload.
• Resourceful self-starter with strong technical acumen.
• Ability to adapt to change and manage multiple priorities.
• Experience in utilization management or health insurance setting beneficial.
• Commitment to quality and production goals.
• Collaborative relationship-building skills.

Benefits

• Flexible work environment.
• Comprehensive benefits package.
• Opportunities for professional development.
• Supportive team culture.
• Commitment to sustainability and innovation.