Utilization Management Nurse Jobs

About The Position

Requirements

• Registered Nurse; a diploma RN is acceptable.
• At least 3 years of experience as a Registered Nurse.
• At least 1 year of clinical experience in an acute or post-acute setting.
• At least 1 year of Utilization Management or Care Management experience.
• Active, current, unrestricted RN licensure in the state of residence; additional nursing licenses may be required as business needs require.
• Effective verbal and written communication skills.
• Computer proficiency, including the ability to navigate multiple systems and keyboard.
• Ability to multitask, prioritize, and adapt effectively in a fast-paced, changing environment.
• Capacity to sit for extended periods, talk on the telephone, and type on a computer.
• Availability to cover both Saturday and Sunday each week.

Nice To Haves

• Associate degree or BSN preferred.
• Utilization Management experience preferred.

Responsibilities

• Gather clinical information and apply appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations across the continuum of care.
• Communicate with providers and other parties to facilitate care and treatment.
• Identify members for referral opportunities to integrate with other products, services, or benefit programs.
• Identify opportunities to promote the quality and effectiveness of healthcare services and benefit utilization.
• Consult with and provide expertise to internal and external constituents involved in coordinating and administering utilization and benefit management.
• Meet productivity and quality expectations established by UMNC.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources to support colleagues’ physical, emotional, and financial well-being, based on eligibility
• Eligibility for a CVS Health bonus, commission, or short-term incentive program