Job Description
- Job Description:
- Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members
- Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care
- Communicate with providers and other parties to facilitate care and treatment
- Identify members for referral opportunities to integrate with other products, services, or benefit programs
- Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
- Meet set productivity and quality expectations as established by UMNC
- Requirements:
- Registered Nurse
- Diploma RN acceptable; Associate degree / BSN preferred
- 3+ years of experience as a Registered Nurse
- 1+ years of clinical experience in acute or post-acute setting
- 1+ years of Utilization Management / Care Management Experience
- Must have active current and unrestricted RN licensure in state of residence
- May be required to obtain additional Nursing Licenses as business needs require
- Utilization review experience preferred
- Experience with LTAC, skilled rehab, or home health preferred
- Managed Care experience preferred
- BSN preferred
- Benefits:
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- Many other benefits depending on eligibility
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