Utilization Management Nurse

CenterWell

18h • Remote

About The Position

The Utilization Management Nurse uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. The Utilization Management Nurse uses clinical knowledge towards interpreting criteria and procedures to provide the best treatment, care, or services for members. You will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will report to a Utilization RN Manager.

Requirements

• Active and unrestricted Registered Nurse license (RN) in the (appropriate state) with no disciplinary action
• 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing experience
• Previous experience in utilization management
• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
• Comprehensive knowledge of Microsoft Word, Outlook and Excel

Nice To Haves

• BSN or Bachelor's degree in a related field
• Health Plan experience
• Previous Medicare/Medicaid Experience
• Call center or triage experience
• Bilingual in English and Spanish with the ability to read/write/speak in both languages

Responsibilities

• Uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations.
• Uses clinical knowledge towards interpreting criteria and procedures to provide the best treatment, care, or services for members.
• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level