Telephonic Utilization Management Nurse (Pacific Southwest Region) - Work at Home - Arizona

Become a part of our caring community and help us put health first
 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.

Helping our Medicare population be healthy and stay healthy! The Utilization Management Nurse 2 utilizes their clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate level of treatment, care or services for members.

• Coordinates and communicates with providers, MDs, and administrative staff to facilitate optimal care and treatment
• Review UM inpatient admission and clinical information to determine appropriate level of care in a fast-paced environment
• Understands resources and role responsibilities as well as reporting structure
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
• Follows established guidelines/procedures to ensure all work is compliant with CMS and NCQA requirements
• Promotes collaboration within own team as well as others

Use your skills to make an impact
 

Required Qualifications

• Licensed Registered Nurse (RN) in the states of AZ, CO, NM or a compact license, with no disciplinary action
• Must be able to work business hours in MST/PST time zone
• 2+ years of prior clinical experience in either an acute care and/or post-acute 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 …