Our well-known healthcare client is searching for multiple Contract Utilization Management Nurses to join their team on a contract basis. In this role, you can work fully remotely from the comfort of your home. If you’re a dynamic individual ready to share your talents and ideas with this team, apply today!
Work model:
- Remote
- Must have an active RN license and reside in Iowa, Illinois, South Dakota, Minnesota, Wisconsin, or Texas
What you will do:
- Provide utilization management service, the transition of care, and support to members and health care providers
- Utilize clinical knowledge and expertise
- Interpret and apply medical policy, medical necessity criteria, InterQual, and benefit information
- Provide consultation and responses to utilization management requests
- Assess and assist members in helping move them through the continuum of care and utilize services and resources efficiently
- Function as part of a multidisciplinary team to continuously look for ways to improve processes and maximize health dollars for members
- Work primarily on prior approval reviews
What you need to be successful:
- Completion of an accredited registered nursing program or licensed practical nursing program
- Active and unrestricted RN or LPN license in Iowa
- 4+ years of diverse clinical experience with direct clinical care to the consumer
- Acute Care, Home Health, and Med Surg experience ideal
- Strong analytical and critical thinking skills
- Ability to work in a fast-paced environment
- Strong understanding of resources, processes, and guidelines
- Commitment to service excellence and patient/member advocacy
- Strong written and verbal communication skills
- Able to develop collaborative relationships with peers and stakeholders to be viewed as a trusted partner
- Ability to learn new systems quickly
- Knowledge of the diagnosis and procedure coding systems
- Measured on Metrics QA/Production metrics: minimum of 25 reviews a day with a 97% QA review
Benefits overview:
- 401k
- Major health insurance
- Employee Stock Ownership Plan (ESOP)
- Click here for a complete list of benefits
Interested and qualified candidates can contact Molly McMahon at (515) 225-7000 or mmcmahon@thepalmergroup.com.
