Utilization Healthcare Specialist

6 days ago


Rockford, Illinois, United States Guidehealth Full time

At Guidehealth, we are dedicated to delivering exceptional healthcare services. As a Nurse Utilization Coordinator, you will play a vital role in our mission to make great healthcare affordable and improve patient outcomes. We offer a comprehensive compensation package, including a salary of $75,000 per year, paid bi-weekly, plus benefits that prioritize your well-being and support your growth.

Job Description:
  • We are seeking a skilled Nurse with experience in utilization review, managed care, and community health to join our team. You will be responsible for performing utilization review services in compliance with federal and state regulations, analyzing clinical data, and documenting findings.
  • You will also complete timely written and verbal communication of pre-certifications and concurrent review determinations for healthcare services. Additionally, you will interface with ordering providers and provider organizations on a routine basis, and may communicate with members or their representatives as needed.
  • Your responsibilities will also include initiating referrals of targeted patients into organized disease management programs, managing and documenting after-hours phone calls from members and providers, and maintaining confidentiality of member information, case records, and file entries.
Required Skills and Qualifications:
  • A registered nurse with an active and unrestricted license in the state of Illinois is required. Five years of experience in various healthcare settings, knowledge of utilization review, managed care, and community health, computer skills, and strong organizational, writing, and speaking skills are necessary.
  • Prioritize and react based on rapidly changing business needs. Excellent clinical judgment, compassion, and a positive attitude are essential.
Benefits:
  • Work from Home: We offer flexible work arrangements to balance your personal and professional life.
  • Keep Health a Priority: Comprehensive Medical, Dental, and Vision plans to keep you covered.
  • Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
  • Have Peace of Mind: Life and Disability insurance for those 'just in case' moments.
  • Feel Supported When You Need It Most: Employee Assistance Program (EAP) to help you through tough times.
  • Take Time for Yourself: Flexible Time Off tailored to meet your needs and the needs of the business.
  • Support Your New Family: Paid parental leave to give you the time you need.
  • Learn and Grow: Resources dedicated to your learning and development to advance your career.


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