DescriptionThe Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- Active RN license in the state(s) in which the nurse is required to practice
- Ability to be licensed in multiple states without restrictions
- Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Proficient with Microsoft Word, Outlook and Excel
- Ability to work independently under general instructions and with a team
- Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
- Education: BSN or Bachelor’s degree in a related field
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Call center or triage experience
- Previous experience in utilization management, discharge planning and/or home health or rehab
- Bilingual is a plus
Hours for this role are: This position is a part-time weekend role working Saturday and Saturday 8am-5pm, along with one day during the week for 4 hours for a total of 20 hours weekly. This position will also on occasion based on a business need will require the 20 hours to be worked during the week instead of the weekend, but the position is primarily a weekend role.
Scheduled Weekly Hours20