Utilization Management Nurse I

Summary

Join our team and contribute to providing best-in-class service to our members, while working hard to put their well-being first. As a Utilization Management Specialist, you will utilize clinical knowledge and expertise to interpret medical policy, medical necessity criteria, and benefit information, and provide consultation and responses to utilization management requests.

Requirements

• Completion of an accredited nursing program or licensed practical nursing program
• Active and unrestricted RN or LPN license in Iowa or South Dakota
• 4+ years of diverse clinical experience (e.g. acute care, outpatient, home health, etc.) that reflects 4+ years of direct clinical care to the consumer
• Previous experience working independently and managing an assigned caseload

Responsibilities

• Provide utilization management review and support to members and health care providers
• Utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical necessity criteria (InterQual), and benefit information
• Proactively assess and assist members to help move them through the continuum of care and to utilize services and resources efficiently

Benefits

Remote work eligibility