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.

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.

Use your skills to make an impact
 

Required Qualifications

• Minimum of associate degree in nursing
• Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
• Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
• Three (3) or more years of progressive clinical experience
• Effective telephonic and virtual communication skills
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and within a team.

 

Work-At-Home Requirements

• 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 is 25mbs download x 10mbs upload is required.
• Check your internet speed at www.speedtest.net
• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.

 

Preferred Qualifications

• BSN
• 2 to 3 years of home health experience and/or utilization management experience
• Experience in a managed care setting
• Health Plan experience
• CGX experience
• Bilingual in English/Spanish

Additional Job Description

-- A secure home-office space, full-time uninterrupted work hours and hard-wired, high-speed internet service is required for this position --

 

The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following:

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Excellent organizational and time management skills
• Solid analytical skills to understand and interpret data to make recommendations to improve patient care. 
• Technical savvy and ability to navigate multiple systems and screens while working cases.
• Collaboration skills to effectively interact with multiple parties both internal and external.