DescriptionThe Telephonic Acute UM Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Telephonic Acute UM Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Telephonic Acute UM Nurse 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.
While this is a work at home position, the preferred candidate will live within the state of Texas and have an active, unrestricted Texas registered nursing license. The preferred candidate will also have acute, hospital based case management / utilization management experience which includes discharge planning.
- Active, unrestricted Texas registered nursing license or the ability to be licensed in TX
- At least 3 years of varied clinical nursing experience
- Utilization management experience which includes following MCG/Milliman or Interqual guidelines
- Prior clinical experience in an acute care, skilled or rehabilitation clinical setting
- Proficient with Microsoft Office products including Word, Excel and Outlook
- 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
- Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
- Bachelor's degree
- Certification in Case Management preferred
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Call center or triage experience
- Bilingual is a plus
Scheduled Weekly Hours40