Utilization Management Nurse

Cottingham & Butler • Des Moines, IA

4h • Remote

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 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, with weekends and holidays off.

Requirements

• Registered Nurse (RN).
• Clinical experience.
• Strong multitasking skills.

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 service requests against evidence-based guidelines to confirm appropriate, timely, and medically necessary care.
• Handle multiple provider phone calls in a fast-paced environment.
• Work with participants to refer them 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, subject to 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.
• Most benefits start on day one.

What This Job Offers

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