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 unrestricted RN license in the state of Florida and ability to be licensed in multiple states without restrictions
- Minimum 3 years experience diverse Medical Surgery, Heart, Lung, Critical Care, SNF or Rehabilitation Nursing experience
- Ability to work four 10 hours shifts including weekends; Every Sat/Sun and two days during week which is flexible
- Ability to work independently under general instructions and with a team
- Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook
- Possession of a valid driver's license and access to a reliable automobile
- Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work
- Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)
- Education: BSN or Bachelor's degree in a related field
- Previous experience in utilization management
- Working knowledge using Milliman or Interqual experience
- 3+ years' experience in a high volume community or mail order pharmacy practice environment.
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Call center or triage experience
- Bilingual is a plus
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Scheduled Weekly Hours40