Responsibilities
The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Required Qualifications
Active RN license in the state(s) in which the nurse is required to practice
Prior acute care clinical experience (3-5 years of experience working in any of the following areas: ER, Critical Care, ICU, Ortho, Med Surg or Tele)
Must have good typing skills and proficiency using MS Office Word, Excel and Outlook
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Ability to work independently under general instructions and with a team
Preferred Qualifications
Education: BSN or Bachelor’s degree in a related field
Health Plan experience
Previous Medicare Experience a plus
Previous experience with MCG
Previous experience in utilization management
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required
Satellite and Wireless Internet service is NOT allowed for this role
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Additional Information
Hours for this role are: This position is a full-time weekend role working Thursday and Friday 8:30am-7:00pm & Saturday and Sunday 6:30am-5:00pm
Scheduled Weekly Hours
40