UMNC
$66,581–$142,584 year
RemoteUnited States
Job Summary
Assess, plan, implement, coordinate, monitor, and evaluate healthcare service options to facilitate appropriate benefits for members. Gather clinical information to apply criteria and guidelines, rendering coverage determinations along the continuum of care. Communicate with providers to facilitate treatment and identify referral opportunities for other products and programs. Consult with internal and external constituents on utilization and benefit management administration. Perform close inspection of handwritten and computer-generated documents while multitasking in a fast-paced environment. Requires proficiency with multiple systems and strong verbal and written communication skills.
Required Qualifications
- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
- Must have active current and unrestricted RN licensure in state of residence
- Must be available for weekends, holidays, and evening hours
Desired Qualifications
- 2+ years of clinical experience required in med surg or specialty area
- Managed Care experience preferred, especially Utilization Management
- Preference for those residing in EST zones
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