Utilization Management Nurse

CenterWell

16h • Remote

About The Position

The Utilization Management RN will collaborate with other health care givers in reviewing medical care and services. This review will involve evaluating actual and proposed care against established CMS Coverage Guidelines/NCQA review criteria. You will be part of a team that focuses on excellent service to others. You will report to a Utilization RN Manager. Use your skills to make an impact.

Requirements

• Active and unrestricted RN license with no disciplinary action
• 5+ years of clinical RN experience
• 5+ years of Acute Care experience in the Hospital ICU or ER settings
• Prior clinical experience, managed care experience, DME, Florida Medicaid OR utilization management experience
• Experience cross training and floating among teams
• Available for On Call weekend/holiday rotation

Nice To Haves

• BSN or bachelor's degree in a related field
• Active and unrestricted Compact Registered Nurse (RN) license with no disciplinary action (including Nevada)
• Experience working within Florida Medicaid
• Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
• Experience in utilization management within Insurance industry
• Medicare Advantage, Medicare or Medicaid Experience
• Current nursing experience in Hospital, SNF, LTAC, DME or Home Health.
• Bilingual in English and Spanish with the ability to read/write and speak in both languages

Responsibilities

• Reviewing medical care and services.
• Evaluating actual and proposed care against established CMS Coverage Guidelines/NCQA review criteria.
• Collaborating with other health care givers.

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