Location: Chicago,
IL Location
Type: Remote
Additional Location: MN; ND; SD; WI;
Schedule: Full_time
Req: R-258638
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.
Responsibilities
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.
Required Qualifications
- Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
- 3+ years of prior clinical experience in a post-acute skilled nursing, acute rehabilitation or LTACH clinical setting
- Previous experience in utilization management, MCG, and CMS criteria
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- 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
- 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 of 10×1 (10mbs download x 1mbs upload) is required
Preferred Qualifications
- BSN or Bachelor’s degree in a related field
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
Additional Information
- Hours for this role are: Monday-Friday 8am-4:30pm CST
- This is a remote/work at home position, candidates being considered must reside in one of these states: Illinois, Minnesota, Wisconsin, North Dakota or South Dakota
Scheduled Weekly Hours
40
