Utilization Management RN

CenterWell

2d • Remote

About The Position

As a Utilization Management Nurse, you will use clinical knowledge and skills to interpret criteria, policies, and procedures. The goal is to provide the best and most appropriate 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 Management Manager. This is a remote position. Use your skills to make an impact.

Requirements

• Active Registered Compact Nurse license (RN) in the home state with no disciplinary action and ability to obtain non-compact licensure.
• 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing clinical experience in Acute care (skilled or rehab clinical settings).
• Self-provided internet service with at least a download speed of 25 Mbps and an upload speed of 10 Mbps.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Utilization management experience.
• BSN or Bachelor's degree in a related field.
• Health Plan experience.
• Previous Medicare or Medicaid Experience.
• Bilingual English and Spanish.

Responsibilities

• Interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.
• Coordinate and communicate with providers, members, or other parties to facilitate care and treatment.
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
• Work rotation and possible holiday coverage required.

Benefits

• Medical benefits
• Dental benefits
• 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 disability
• Long-term disability
• Life insurance
• Bi-weekly payment for internet expense (for employees in California, Illinois, Montana, or South Dakota)
• Telephone equipment provided
• Bonus incentive plan

What This Job Offers

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