Utilization Management Nurse

HealthCheck360•Dubuque, IA

2d•Hybrid

About The Position

We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, and prefers working in a professional office setting with daytime office hours and weekends/holidays off. 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

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.
Handling multiple provider phone calls at any given time.
Work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines.