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Utilization Management Registered Nurse
2 months ago
The Utilization Management Registered Nurse plays a crucial role in leveraging clinical expertise to facilitate the organization, documentation, and communication of medical services and benefit determinations. This position involves diverse responsibilities that often require analytical thinking and independent judgment to determine the most suitable actions.
The Utilization Management RN applies clinical knowledge, effective communication, and critical thinking skills to interpret guidelines, policies, and procedures, ensuring optimal treatment and care for members. This role involves coordinating and liaising with healthcare providers, members, and other stakeholders to enhance care delivery. A comprehensive understanding of departmental and organizational strategies, as well as their interconnections, is essential. The RN is expected to make informed decisions regarding work methods, often in ambiguous scenarios, with minimal supervision and guidance as necessary. Adherence to established protocols and procedures is mandatory.
Utilize your expertise to create a positive impact
Essential Qualifications
- Current and unrestricted Registered Nurse (RN) license in the appropriate state without any disciplinary actions.
Minimum of 3 years of experience in a Skilled Nursing Facility
Prior experience in Utilization Management is mandatory
Clinical experience in acute care, skilled nursing, or rehabilitation settings is preferred.
Proficient in Microsoft Word, Outlook, and Excel.
Ability to work autonomously under general supervision and collaboratively within a team.
A reliable high-speed DSL or cable modem is necessary for remote work (Satellite and Wireless Internet services are not acceptable). A minimum speed of 10x1 (10mbs download x 1mbs upload) is required for optimal performance.
A strong commitment to enhancing consumer experiences is essential.
Preferred Qualifications
Education: BSN or a Bachelor’s degree in a related discipline.
Experience in Health Plans is advantageous.
Familiarity with Medicare/Medicaid is a plus.
Experience in call centers or triage settings is beneficial.
Bilingual candidates are encouraged to apply.
Additional Information
Scheduled Weekly Hours
40
Compensation Range
The compensation range provided reflects a good faith estimate of starting base pay for full-time employment. The actual pay may vary based on geographic location and individual qualifications, skills, knowledge, experience, and education. The estimated range is $69,800 - $96,200 annually. This position is eligible for a bonus incentive plan based on individual and company performance.
Benefits Overview
Health eCareers offers a competitive benefits package designed to support the overall well-being of associates. Benefits include medical, dental, and vision coverage, a 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance, and additional opportunities for personal and professional growth.
About Health eCareers
Health eCareers is dedicated to prioritizing health for our employees, clients, and the communities we serve. Through our comprehensive healthcare services, we strive to simplify the process for individuals to achieve their best health outcomes, ensuring timely access to necessary care and services.
Equal Opportunity Employer
Health eCareers is committed to creating a diverse environment and is proud to be an equal opportunity employer. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We actively seek to employ and advance individuals from all backgrounds based on valid job requirements.
