Utilization Management Nurse – Weekend Schedule (Central Region)
Remote US
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.
Creating Healthy Communities is good for the Soul. Join Us! 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.
**This is a weekend role and the hours are: Tuesday-Saturday or Wednesday-Sunday 7am-4pm CST or 8am-5pm CST ** (Every Saturday is a required workday)
- Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps
- Review UM inpatient admission and clinical information to determine appropriate level of care
- 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
Use your skills to make an impact
Required Qualifications
- Licensed Registered Nurse (RN) with a Compact license or licensed in Minnesota and/or Illinois with no disciplinary action
- 3+ years of prior clinical experience preferably in an acute care hospital clinical setting
- Utilization Management experience is required
- Milliman/MCG or InterQual experience is required
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Excellent communication skills both verbal and written
- 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
Preferred Qualifications
- Bachelor's degree in nursing (BSN)
- Health Plan experience
- Previous Medicare experience a plus
- CGX experience
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their …
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California Dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Illinois Montana Remote position Remote US South Dakota Work-At-Home Work-At-Home Requirements Work from a dedicated space Work from a dedicated space lacking ongoing interruptions Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Work from Home in the state of California, Illinois, Montana, or South Dakota
Benefits/Perks401k retirement 401k Retirement Savings Bonus Incentive Bonus incentive plan Caring community Competitive benefits Dental Disability Holidays Internet expense reimbursement Life Life Insurance Medical Paid parental and caregiver leave Paid Time Off Parental and Caregiver Leave Personal holidays Remote position Smart healthcare decisions Support whole-person well-being Telephone equipment provided Time off Vision Vision Benefits Volunteer time Volunteer time off Work-At-Home Work From Home
Tasks- Communication
- Determinations
- Documentation
- Interpretation
- Planning
- Training
- Utilization Management
Acute care BI Business Clinical Clinical Experience Clinical knowledge Clinical Nursing Communication Compensation Consumer Experiences Critical thinking Dental Discharge planning Documentation Excel Healthcare Healthcare services Health Plan Experience HIPAA Insurance Interpreting Criteria InterQual Leadership Life Insurance Management MCG Medicaid Medical Services Medicare Microsoft Microsoft Excel Microsoft Outlook Microsoft Word Milliman Nursing Organization Organizational Outlook Planning Policy Recruitment Registered Nurse RN Strategy Training Utilization management Vision Wellness Word Workday
Experience3 years
EducationAssociate Associates Bachelor's Bachelor's degree Bachelor’s Degree in Nursing BSN Business Communication Education Healthcare Higher IT Management Nursing Registered Nurse RN
CertificationsCompact License Licensed registered nurse Registered Nurse RN
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9