Job Description:
• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
• Communicates with providers and other parties to facilitate care/treatment
• Identifies members for referral opportunities to integrate with other products, services and/or programs
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
• Typical office working environment with productivity and quality expectations
• Work requires the ability to perform close inspection of handwritten and computer generated documents as well as a PC monitor
• Sedentary work involving periods of sitting, talking, listening
• Work requires sitting for extended periods, talking on the telephone and typing on the computer
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Requirements:
• 5 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
• 4 - 10 hour shifts every Saturday and Sunday and two weekdays
• Monday - Friday training is required prior to transferring to weekends
• Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
• 3+ years of clinical experience required in med surg or specialty area preferred
• Managed Care experience preferred, especially Utilization Management
• Preference for those residing in ET zones
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