Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
As a Registered Nurse (RN) – Utilization Management, you will join a fast-paced, collaborative team to help ensure members receive the appropriate care and benefits while making a meaningful impact on healthcare outcomes.
Responsibilities
- Review clinical information and apply evidence-based criteria to support coverage determinations
- Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
- Collaborate with providers and care teams to facilitate appropriate treatment plans
- Identify opportunities to improve quality, efficiency, and healthcare utilization
- Connect members to additional programs and services as appropriate
- Serve as a clinical resource for internal and external stakeholders
Requirements
- Active, unrestricted RN license in your state of residence
- 2+ years of adult acute care and/or critical care nursing experience
- Strong clinical assessment and decision-making skills
- Ability to navigate multiple computer systems and manage competing priorities
- Excellent verbal and written communication skills
- Associate Degree in Nursing required
- Willing to work weekends, holidays, and evening shifts
Preferred Qualifications
- 2+ years of Med-Surg or specialty nursing experience
- Managed Care experience, particularly Utilization Management
- Reside in the Eastern Time Zone
- BSN preferred
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
Technical and Logistical Requirements
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency
- Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace)
- Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links
- Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues
Anticipated Weekly Hours
- 40
Time Type
- Full time
Pay Range
- $29.10 - $68.55