Telephonic Utilization Management Nurse (RN) - Work at home, Mountain or Pacific Time zones

The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Utilization Management 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.
Ideal candidate
The ideal candidate for this position will live within the Mountain or Pacific Time zones, have an active and unrestricted RN license and a background working in utilization management.
Required Qualifications
Active and unrestricted registered nursing license
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.
Preferred Qualifications
Bachelor's degree
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus
Scheduled Weekly Hours

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