UM Nurse- Compact License required
About the position 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. 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 when needed. Follows established guidelines/procedures. Responsibilities • Utilize clinical nursing skills to support coordination and documentation of medical services. • Interpret criteria, policies, and procedures to provide appropriate treatment and care. • Coordinate and communicate with providers and members to facilitate optimal care. • Make independent decisions regarding work methods in ambiguous situations. • Follow established guidelines and procedures. Requirements • Minimum of associate degree in nursing. • Licensed Registered Nurse (RN) in a compact state with no disciplinary action. • Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure. • Three (3) or more years of progressive clinical experience. • Effective telephonic and virtual communication skills. • Comprehensive knowledge of Microsoft Word, Outlook, and Excel. • Ability to work independently under general instructions and within a team. Nice-to-haves • BSN. • 2 to 3 years of home health experience and/or utilization management experience. • Experience in a managed care setting. • Health Plan experience. • CGX experience. • Bilingual in English/Spanish. Benefits • Medical, dental, and vision benefits. • 401(k) retirement savings plan. • Paid time off including company and personal holidays. • Volunteer time off. • Paid parental and caregiver leave. • Short-term and long-term disability. • Life insurance. Apply tot his job