Position Summary

This is a fulltime remote Utilization Management opportunity. The schedule is Monday through Friday, 8am-5pm in the time zone of residence, some varying hours with holiday, weekend, and late rotations.

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or benefit programs.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• UMNC meets set productivity and quality expectations.
• Effective communication skills, both verbal and written
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
• Work requires sitting for extended periods, talking on the telephone and typing on the computer.
• Work from home position: During work hours, Colleagues who are working from home must be available by phone, videoconference, and email in a manner and frequency that is required by the Colleague’s Leader. Colleagues must be available from time to time to come into the office or client location on a given day for work-related meetings, training sessions or other events, as directed by their Leader.

Required Qualifications

• 3+ years of clinical experience as a Registered Nurse
• 1+ years of clinical experience in acute or post-acute setting
• Must have active current and unrestricted RN licensure in state of residence
• Willing and able to obtain additional nursing licenses as business needs arise

Preferred Qualifications

• Critical care or ER experience
• Utilization review experience
• Managed Care experience

Education

• Minimum of a diploma RN or associate degree in nursing required
• BSN preferred