Utilization Registered Nurse

DMBA (Deseret Mutual Benefit Administrators) is a non-profit organization that administers benefits for companies who are owned or affiliated with The Church of Jesus Christ of Latter-day Saints.

We have an opening for an experienced Registered Nurse to work in our Medical Utilization Management Department.

This associate will be responsible to work within the DMBA Medical Utilization Management Program. The associate will be performing utilization review and preauthorization activities for Inpatient mental and behavioral health stays, Residential Treatment Center stays, and Partial Hospitalization Program and Intensive Outpatient Program participation. There may be some opportunity to cross train in the med/surg side of utilization review as well.

Work environment: Hybrid work - start training in the office daily for a minimum of 6 weeks. Transition to working once a week in the office and the rest of the time from home. DMBA reserves the right to modify the hybrid schedule. The associate will be responsible for maintaining a private and secure workspace in their residence. Full-Time: Monday - Friday.

REQUIRED TRAINING, SKILLS, AND KNOWLEDGE:

• Licensed as an R.N. in the state of Utah or in a state that participates in the Nurse Licensure Compact (NLC)
• Graduate of an accredited nursing school with an Associate, Bachelor, or Masters degree
• Minimum 5 years Psychiatric clinical nursing experience
• Excellent written and oral communication skills
• Experience with Microsoft Office applications: e.g., Word, Excel, and Teams

PREFERRED TRAINING, SKILLS, AND KNOWLEDGE:

• 10 years acute care clinical nursing experience, with at least 1 year of Med-Surg
• Experience in healthcare delivery and managed care systems and processes
• Managed Care experience as a Case Management Nurse
• Managed Care experience as a Utilization Nurse with preauthorization and concurrent review processes
• Familiarity with MCG (formerly Milliman Care Guidelines) or InterQual Level of Care criteria
• Experience with medical claims review and coding
• Experience as a charge nurse or managing nurses in a clinical or administrative setting
• Experience adapting to and working in various software applications

DESIRED TALENTS:

• Excellent organizational skills
• Ability to self-start, self-motivate, and self-pace
• Ability to work autonomously in a team environment
• Excellent critical thinking, problem solving, and decision-making skills
• Ability to professionally communicate with internal and external contacts
• Ability to communicate with providers, vendors, facilities, and participants in a professional manner
• Ability to assess healthcare, social and behavioral health needs, and other issues with participants for referral to care and disease management programs
• Ability to analyze and report utilization management findings and activities

• Ability to network within the health care delivery system

WHAT WE OFFER:

• Competitive pay
• Rich medical, vision and dental benefits with low premiums. One of the top health plans in Utah
• Rich retirement planning: including 401(k) company match, 8% EDRC Employer Discretionary Retirement Contribution (we just give you free money for retirement), life insurance, and full service Financial Planners onsite at no cost
• Generous paid leave plan that starts accruing your first day, your birthday off, additional sick leave and 12 paid holidays
• Award winning wellness program with health coaching, ability to earn 3 additional days off a year, fun activities and an onsite gym.
• Tuition reimbursement
• Career development through company sponsored programs and over 5000 on-demand online training courses.
• Hybrid work schedules available depending on position
• Employee Assistance Program