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.
• Position is Monday through Friday varying hours available with Holiday, Weekend, and late rotations.

Required Qualifications

• Active current and unrestricted Registered Nurse in the state of residence
• Willing and able to obtain additional Nursing Licenses as business needs require
• 3+ years of experience as a Registered Nurse
• 1+ years of clinical experience in acute or post-acute setting

• Candidates must be able to work Monday - Friday 8:00am-5pm in the time zone of residence. Some weekends, holidays, and late rotations may be required

Preferred Qualifications

• Critical care experience i.e. ICU, CCU, NICU, ER
• Utilization review experience
• Managed Care experience
• Experience working with MS office applications such as Teams, Outlook, Excel, and Word

Education

• Diploma RN or Associate degree in Nursing required
• BSN preferred