Utilization Management Nurse

3 days ago

Salt Lake, Utah, United States American Cybersystems Full time
About the Role

We are seeking a highly skilled Utilization Management Nurse to join our Clinical Services team. As a Utilization Management Nurse, you will play a critical role in ensuring that our members receive the most appropriate and cost-effective care possible.

Key Responsibilities
  • Conduct utilization management reviews to ensure medical necessity and compliance with policy and standards of care.
  • Apply clinical expertise and evidence-based criteria to make determinations and consult with physician advisors as needed.
  • Collaborate with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues.
  • Serve as a resource to internal and external customers, providing accurate and timely responses to inquiries.
  • Identify opportunities for improvement and participate in quality improvement efforts.
  • Maintain accurate and consistent documentation and prioritize assignments to meet performance standards and corporate goals.
  • Protect confidentiality of sensitive documents and issues while communicating professionally with members, providers, and regulatory organizations.
Requirements
  • Associate or Bachelor's Degree in Nursing or related field.
  • 3 years of case management, utilization management, disease management, auditing or retrospective review experience.
  • Equivalent combination of education and experience.
  • Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline.
  • May need to have licensure in all four states served by Cambia: Idaho, Oregon, Utah, Washington.
  • Must have at least one of the following: Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Masters' degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management).
What We Offer
  • Competitive salary and bonus opportunities.
  • Market-leading 401(k) with a significant company match.
  • Generous paid time off and 10 company-paid holidays.
  • Up to 12 weeks of paid parental time off.
  • Award-winning wellness programs.
  • Employee Assistance Fund for those in need.
  • Commute and parking benefits.
About Cambia

Cambia is a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. We are committed to helping our members live healthy lives and making healthcare easier and lives better. We believe in the importance of work-life balance and offer a range of benefits to support our employees in achieving their goals.

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