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Utilization Management Registered Nurse
2 months ago
The Utilization Management Registered Nurse plays a vital role in the assessment, documentation, and communication of medical services and benefit administration decisions. This position involves diverse responsibilities that often require independent judgment and interpretation of appropriate actions.
The Utilization Management RN employs clinical expertise, effective communication, and critical thinking to interpret policies, criteria, and procedures, ensuring optimal treatment and care for members. This role necessitates collaboration with providers, members, and other stakeholders to facilitate the best possible care outcomes. A solid understanding of departmental and organizational strategies, along with their interconnections, is essential. The RN will make decisions regarding their work methods, often in uncertain situations, with minimal supervision while adhering to established guidelines.
Utilize your expertise to create a positive impact
Essential Qualifications
- Active Registered Nurse (RN) license in the appropriate state without any disciplinary actions.
Minimum of 3 years experience in Skilled Nursing Facilities
Prior experience in Utilization Management is essential
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 guidance and collaboratively within a team.
Must provide a high-speed DSL or cable modem for remote work (Satellite and Wireless Internet are not permitted). A minimum speed of 10x1 (10mbs download x 1mbs upload) is required for optimal performance.
A passion for enhancing consumer experiences within a progressive organization is essential.
Preferred Qualifications
Education: BSN or a Bachelor's degree in a related field.
Experience in Health Plans is advantageous.
Prior Medicare/Medicaid experience is a plus.
Experience in call centers or triage is beneficial.
Bilingual candidates are encouraged to apply.
Additional Information
Scheduled Weekly Hours
40
Compensation Range
The salary range below represents a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The actual pay may vary based on geographic location and individual qualifications, including skills, knowledge, experience, education, and certifications. $69,800 - $96,200 per year. This position is eligible for a bonus incentive plan based on company and/or individual performance.
Benefits Overview
Health eCareers offers competitive benefits designed to support overall well-being. Benefits include medical, dental, and vision coverage, a 401(k) retirement savings plan, paid time off (including personal holidays, volunteer time off, and paid parental leave), short-term and long-term disability, life insurance, and various other opportunities.
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 empower individuals to achieve their best health by providing the necessary care and support.
Equal Opportunity Employer
Health eCareers is committed to ensuring equal employment opportunities for all individuals, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We actively promote diversity and inclusion in our workforce.
