Nurse Utilization Management Senior

6 days ago


Miami, United States Elevance Health, Inc. Full time
Job Summary

We are seeking a highly skilled Senior Registered Nurse to join our Utilization Review and Management team at Elevance Health, Inc. As a key member of our team, you will be responsible for reviewing and managing patient care to ensure optimal outcomes and efficient use of healthcare resources.

Key Responsibilities
  • Conduct thorough reviews of patient medical records to identify areas for improvement in care coordination and resource utilization.
  • Develop and implement effective care plans to ensure patients receive the most appropriate level of care.
  • Collaborate with healthcare providers, payers, and other stakeholders to ensure seamless care transitions and optimal resource allocation.
  • Provide education and support to patients, families, and caregivers to promote self-management and empowerment.
  • Stay up-to-date with industry trends, best practices, and regulatory requirements to ensure compliance and quality care.
Requirements
  • Current RN licensure in the state of practice.
  • Minimum 3 years of experience in utilization review, case management, or a related field.
  • Strong analytical and problem-solving skills, with ability to interpret complex medical data.
  • Excellent communication and interpersonal skills, with ability to work effectively with diverse stakeholders.
  • Proficiency in electronic health records and other relevant software systems.


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