Utilization Management Nurse
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 care and treatment. You will understand department, segment, and organizational strategy and operating goals, 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
- Health Plan experience
- Previous Medicare/Medicaid 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 care and treatment.
- Understands department, segment, and organizational strategy and operating goals, 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
