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The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
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.
Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
3-5 years of acute care experience in a hospital clinical setting
Must have good typing skills and proficiency using MS Office Word, Excel and Outlook
Ability to work independently under general instructions and with a team
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
Education: BSN or Bachelor's degree in a related field
Utilization management preferred
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Experience working with CMS guidelines a plus
Call center or triage experience
Hours for this role are: Monday-Friday, 8am-5pm with a weekend rotation.
The following policy applies ONLY to associates working in the state of Arizona: Company is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective April 1, 2011, Company has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter
Scheduled Weekly Hours
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