RN Utilization Management Nurse Sr.
3 weeks ago
We are seeking a highly skilled and experienced RN Utilization Management Nurse Sr. to join our team at Elevance Health. As a key member of our medical management team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.
Key Responsibilities- Lead a team of nurses in medical management, ensuring that members receive medically appropriate and high-quality care.
- Collaborate with healthcare providers and members to promote quality outcomes and optimize benefits.
- Review and assess the medical necessity of inpatient admissions, outpatient services, and other medical services.
- Develop and implement effective care plans to ensure that members receive the most appropriate and cost-effective care.
- Work with medical directors to interpret appropriateness of care and ensure accurate claims payment.
- Manage appeals for services denied and ensure consistency in benefit application.
- Current active unrestricted RN license in the state of Florida.
- Minimum of 5 years acute care clinical experience, utilization management or managed care experience.
- Strong knowledge of medical management processes and ability to interpret and apply member contracts, member benefits, and managed care products.
- Excellent communication and leadership skills.
At Elevance Health, we offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also offer medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources.
We operate in a Hybrid Workforce Strategy, with associates required to work at an Elevance Health location at least once per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19.
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