Utilization Management Nurse Consultant – Weekend
Job Description:
• Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members
• Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care
• Communicate with providers and other parties to facilitate care and treatment
• Identify members for referral opportunities to integrate with other products, services, or benefit programs
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
• Meet set productivity and quality expectations as established by UMNC
Requirements:
• Registered Nurse
• Diploma RN acceptable; Associate degree / BSN preferred
• 3+ years of experience as a Registered Nurse
• 1+ years of clinical experience in acute or post-acute setting
• 1+ years of Utilization Management / Care Management Experience
• Must have active current and unrestricted RN licensure in state of residence
• May be required to obtain additional Nursing Licenses as business needs require
• Utilization review experience preferred
• Experience with LTAC, skilled rehab, or home health preferred
• Managed Care experience preferred
• BSN preferred
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
• Many other benefits depending on eligibility
Apply tot his job
Apply To this Job
• Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members
• Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care
• Communicate with providers and other parties to facilitate care and treatment
• Identify members for referral opportunities to integrate with other products, services, or benefit programs
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
• Meet set productivity and quality expectations as established by UMNC
Requirements:
• Registered Nurse
• Diploma RN acceptable; Associate degree / BSN preferred
• 3+ years of experience as a Registered Nurse
• 1+ years of clinical experience in acute or post-acute setting
• 1+ years of Utilization Management / Care Management Experience
• Must have active current and unrestricted RN licensure in state of residence
• May be required to obtain additional Nursing Licenses as business needs require
• Utilization review experience preferred
• Experience with LTAC, skilled rehab, or home health preferred
• Managed Care experience preferred
• BSN preferred
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
• Many other benefits depending on eligibility
Apply tot his job
Apply To this Job