RN -Utilization Management - Post Acute - WAH in Florida preferred

Profile

Description

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 state of Florida with no disciplinary action or compact state license
3-5 years Acute (varied Med Surg, ER, ICU, CCU), skilled and or Rehab experience
1 year utilization management or utilization review experience within a hospital, skilled nursing, health plan, or MSO/PCP office
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Ability to work independently under general instructions and with a team
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is prohibited). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required


Preferred Qualifications


Education: BSN or Bachelor's degree in a related field
Case Management and or discharge planning
Compact license or ability to obtain
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Bilingual is a plus


Additional Information

This position is work at home; RN residing in Dade, Broward or Palm Beach Counties preferred

Scheduled Weekly Hours

40

Company info

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