Utilization Management Nurse - Remote

Overview

The Utilization Management Nurse utilizes clinical skills to assess, coordinate, document, and communicate all aspects of the utilization management department.

In Short

• Utilizes clinical experience in a collaborative process to assess and plan healthcare services.
• Conducts evaluations of members' needs and plans benefits.
• Ensures safe discharge plans for members.
• Documents in the Utilization Management business application according to defined standards.
• Applies clinical criteria to make timely coverage determinations.
• Communicates with providers to facilitate care and treatment.
• Identifies members for referral opportunities to integrate into other programs.
• Presents cases at interdisciplinary care team meetings.
• Complies with regulatory and company policies.

Requirements

• Registered Nurse with unrestricted licensure.
• 3-5 years relevant clinical experience.
• Confidence in working independently and collaborating virtually.
• Strong analytical and problem-solving skills.
• Effective communication and organizational skills.
• Proficiency in navigating multiple systems.
• Experience with MS Office applications.

Benefits

• Competitive salary based on the market.
• Medical, Dental, and Vision insurance.
• Employer-Paid Life Insurance.
• 401(K) match up to 4%.
• Paid-Time-Off.
• Supplemental benefits available.