Utilization Management Nurse

Cottingham & Butler • Davenport, IA

4h

About The Position

The Utilization Management Nurse works telephonically with providers to evaluate and pre-certify requests for services such as hospital stays, outpatient surgeries, outpatient tests, and other care. The nurse reviews requests against evidence-based guidelines to ensure that care is appropriate, medically necessary, and provided at the right time.

The role involves handling multiple provider phone calls in a fast-paced environment and working closely with participants to refer them to case management and condition management services according to referral criteria and health plan guidelines. The position is onsite in Dubuque, Iowa, with remote applicants also accepted. It offers daytime office hours and weekends and holidays off.

Requirements

• Registered Nurse (RN).
• Clinical experience.
• Strong multitasking skills.
• Ability to handle a fast-paced environment.

Nice To Haves

• Experience in emergency room, intensive care, mental health, orthopedics, and/or pain management.
• Bilingual.

Responsibilities

• Work telephonically with providers to evaluate and pre-certify requests for hospital stays, outpatient surgeries, outpatient tests, and other care.
• Review requests against evidence-based guidelines to determine whether services are appropriate and medically necessary.
• Handle multiple provider phone calls in a fast-paced environment.
• Work with participants to make referrals to case management and condition management services according to referral criteria and health plan guidelines.

Benefits

• Medical, dental, and vision insurance.
• Flexible spending account or health savings account.
• 401(k) with company match.
• Profit-sharing/defined contribution plan after a one-year waiting period.
• Paid time off and paid holidays.
• Company-paid short-term and long-term disability.
• Maternity leave and parental leave.
• Subsidized parking.
• Company-paid term life and accidental death insurance.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed