DescriptionThe Telephonic UM Front End Review Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Telephonic UM Front End Review Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Telephonic UM Front End Review 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.
Full time- Monday-Friday with potential for some weekends (no more than 2/month)
WAH position from day one - open to anywhere in US but must be able to work in Pacific and Mountain Standard Time zones
- Able to work in fast-paced environment.
- Familiar with office technologies and electronic medical record systems
- Customer service skills/experience
- Effective written and verbal communication
- Prior UR experience is a plus
- 2-3+ years of Acute care experience
- Experience working with virtual team is a plus
- Licensed Registered Nurse (RN)
- 2+ years of Acute care experience
- Comprehensive knowledge of 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
- Bilingual is a plus
Scheduled Weekly Hours1