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Inpatient Review Nurse
Confirmed live in the last 24 hours
Bloomington, MN, USA
Experience Level
Desired Skills
  • Bachelor's or Associate's degree in Nursing required
  • Three (3) years of utilization management and quality improvement experience are required
  • Working knowledge and understanding of basic utilization management concepts are required
  • Experience interpreting clinical criteria into clear determinations
  • Excellent writing skills, particularly in determination notification writing
  • Must be self-motivated, able to take initiative, and able to thrive and drive results in a collaborative environment
  • Experience in using the Microsoft Office Suite including Excel and Word as well as demonstrated ability to learn/adapt to other computer-based systems and tools
  • Provides a first-level clinical review for all medical and surgical authorization requests against applicable criteria, policies, and procedures. Accurately documents all reviews and contacts providers and members according to established timeframes
  • Acts as a member advocate by expediting the care process through the continuum, working in concert with the healthcare delivery team to maintain high-quality and cost-effective care delivery
  • Screening and coordination of cases within the utilization management department and other Bright clinical teams including Case Management, and Discharge Planning to ensure optimal care for members
  • Escalates all potential quality issues and grievances to correct Bright workflows
  • The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer
  • Travel may be required
Bright Health

1,001-5,000 employees

Affordable personalized health insurance
Company Overview
Bright Health's mission is to make healthcare right. They believe quality health insurance should be simple, personal, and affordable. So they design easy-to-understand plans with benefits you'll actually use. Benefit-packed plans and surprisingly low rates mean you can focus on staying happy and healthy.
  • Compensation and retirement - Performance bonus, Stock Options, 401k plan, 401k matching, Commuter assistance plans
  • Health and wellness - Health insurance, Dental insurance, Vision insurance, Life insurance, Disability insurance, FSA (Flexible Spending Plan), EAP (Employee Assistance Program)
  • Vacation and time off - Unlimited time off, Paid holidays, Flexible working hours, Maternity benefits, Paternity benefits
  • Values and quality of life - Public Transportation, Bike parking, Employee groups and committees, Snacks and beverages
Company Core Values
  • Be brave - Challenge the status quo with curiosity, courage, and tenacity
  • Be brilliant - Deliver predictable excellence with a learning mindset
  • Be accountable - Live by your word, always
  • Be inclusive - Value all voices and contributions to achieve big things
  • Be collaborative - Fearlessly partner with all people