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Registered Nurse for Utilization Management
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 administration decisions. This position involves diverse responsibilities that often require independent judgment and interpretation of appropriate actions.
The Registered Nurse utilizes clinical acumen, effective communication, and critical thinking to assess criteria, policies, and procedures, ensuring optimal treatment and care for members. This role involves collaboration with healthcare providers, members, and other stakeholders to promote effective care delivery. The nurse must understand departmental and organizational strategies and how they interconnect with various operational areas. Decision-making is a key component of this role, often requiring navigation through ambiguous situations with minimal guidance while adhering to established protocols.
Utilize your expertise to make a difference
Essential Qualifications
- Active Registered Nurse (RN) license in the relevant state without any disciplinary actions.
Minimum of 3 years of experience in a Skilled Nursing Facility
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 supervision as well as collaboratively within a team.
Must have a reliable high-speed DSL or cable modem for remote work (Satellite and Wireless Internet services are not permitted). 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 field.
Experience in a Health Plan setting.
Familiarity with Medicare/Medicaid is advantageous.
Experience in call center or triage roles is a plus.
Bilingual candidates are encouraged to apply.
Additional Information
Scheduled Weekly Hours
40
Compensation Range
The compensation range reflects a good faith estimate of starting base pay for full-time employment. The range may vary based on geographic location and individual qualifications, including skills, knowledge, experience, and education. The estimated salary range is $69,800 - $96,200 per year. This position is eligible for a bonus incentive plan based on company and individual performance.
Benefits Overview
Health eCareers offers a comprehensive benefits package that promotes overall well-being. 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 various other opportunities.
About Health eCareers
Health eCareers is dedicated to prioritizing health for our employees, clients, and the communities we serve. Through our services, we strive to make it easier for individuals to achieve their best health by providing the necessary care and support when needed.
Equal Opportunity Employer
Health eCareers is committed to a policy of equal employment opportunity and does not discriminate against any employee or applicant based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We take affirmative action to employ and advance in employment all qualified individuals.
