Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
Position Summary
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
Schedule: 3-11 or 11-8
Location: Remote (Central Time)
- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with other products, services and/or programs.
- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Typical office working environment with productivity and quality expectations.
- Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
- Sedentary work involving periods of sitting, talking, listening.
- Work requires sitting for extended periods, talking on the telephone and typing on the computer.
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
- Effective communication skills, both verbal and written.
Required Qualifications
- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting.
- Must have active current and unrestricted RN licensure in state of residence.
- Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
Preferred Qualifications
- 2+ years of clinical experience required in med surg or specialty area.
- Managed Care experience preferred, especially Utilization Management.
- Preference for those residing in Central Time zones.
Education
- Associates Degree required.
- BSN preferred.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
$26.01 - $56.14
Benefits
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.