SNF Utilization Management RN

About This Role

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. This role requires interpreting criteria, policies, and procedures to provide optimal treatment, care or services for members. The nurse coordinates and communicates with providers, members, or other parties to facilitate care.

Responsibilities

• Utilize clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations
• Interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment
• Understand department, segment, and organizational strategy and operating objectives
• Make decisions regarding own work methods, occasionally in ambiguous situations
• Follow established guidelines/procedures

Requirements

• Licensed Registered Nurse (RN) with no disciplinary action
• Compact License
• Greater than one year of clinical experience in an RN role in acute care setting
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently
• Passionate about contributing to an organization focused on continuously improving consumer experiences
• Ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed)
• Dedicated office space lacking ongoing interruptions to meet productivity requirements and protect member PHI / HIPAA information

Qualifications

• Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.

Nice to Have

• BSN or Bachelor's degree in a related field
• Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc.
• Experience as an MDS Coordinator or discharge planner in an acute care setting
• Previous experience in utilization management/utilization review for a health plan or acute care setting
• Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon
• Health Plan experience
• Previous Medicare/Medicaid Experience
• Call center or triage experience

Skills

* Required skills

Benefits