Utilization Management Nurse

Cottingham & Butler•Dubuque, IA

2d•Hybrid

About The Position

This position is responsible for working telephonically with providers to evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc. Review requests and match up to an evidence-based guideline to ensure proper care and ensure the right service is happening at the right time and is medically necessary. In this position you will be handling multiple provider phone calls at any given time and need to be able to handle a very fast paced environment. You will also work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines.

Requirements

RN and clinical experience
Strong multitasking skills

Nice To Haves

Experience in ER, ICU, mental health, orthopedics, and/or pain management
Bilingual

Responsibilities

Evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, and care telephonically with providers.
Review requests and match them to evidence-based guidelines to ensure proper care.
Ensure the right service is happening at the right time and is medically necessary.
Handle multiple provider phone calls simultaneously in a fast-paced environment.
Work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines.