Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.
Job Summary Utilization Management is a 24/7 operation, and work schedules will include weekends, holidays, and evening hours. As a Utilization Management Registered Nurse, you will utilize 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.
Responsibilities
- Gather clinical information and apply clinical criteria/guidelines, policies, procedures, and clinical judgment to render coverage determinations/recommendations along the continuum of care.
- Communicate with providers and other parties to facilitate care/treatment.
- Identify members for referral opportunities to integrate with other products, services, and programs.
- Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Requirements
- 2+ years of experience as a Registered Nurse in an adult acute care/critical care setting.
- Active current and unrestricted RN licensure in the state of residence.
- Associates degree required; BSN preferred.
Preferred Qualifications
- 2+ years of clinical experience in med-surg or specialty area.
- Managed Care experience preferred, especially Utilization Management.
- Preference for those residing in PST zones.
Work from Home Requirements
- Direct/hardwired internet connection to a modem/router within 7 feet of computer.
- Quiet, secure, and private designated home virtual work location.
- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
Technical and Logistical Requirements
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
- 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, lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
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.
Anticipated Weekly Hours 40
Time Type Full-time
Pay Range $26.01 - $56.14