Acute Utilization Management Nurse - Work at Home KY

Profile

Description

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Utilization Management Nurse 2 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.

Required Qualifications


Active RN license in the state(s) in which the nurse is required to practice
Prior acute care clinical experience
Must have good typing skills and proficiency using MS Office Word, Excel and Outlook
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
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


Preferred Qualifications


Education: BSN or Bachelor's degree in a related field
Health Plan experience
Previous Medicare Experience a plus
Previous experience with MCG
Previous experience in utilization management


Additional Information


Hours for this role are: Monday-Friday 10am-7pm EST


Scheduled Weekly Hours

40

Company info

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