Full-Time
Utilization Management Nurse
HealthCheck360
No salary listed
Dubuque, IA, USA
Remote
Remote applicants welcome.
Category
 Medical, Clinical & Veterinary (1) |
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Requirements
- Registered Nurse (RN) license and clinical nursing experience, preferably in Emergency Room, Intensive Care Unit, mental health, orthopedics, and/or pain management
- Strong multitasking skills and ability to handle multiple provider phone calls in a fast-paced environment
- Experience evaluating and pre-certifying requests such as hospital stays, outpatient surgeries, outpatient tests, and related care, and making determinations based on evidence-based guidelines
- Willingness to work telephonically with providers; onsite in Dubuque, Iowa or remote eligibility
Responsibilities
- Work telephonically with providers to evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc.
- Review requests and match up to evidence-based guidelines to ensure proper care and ensure the right service is happening at the right time and is medically necessary.
- Handle multiple provider phone calls at any given time in a fast-paced environment
- Collaborate with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines
Desired Qualifications
- Bilingual is preferred
- Experience in utilization management or health plan guidelines is preferred