POST ACUTE RN REVIEW NURSE

About the position The Utilization Management Nurse plays a crucial role in the reputed company system by utilizing clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. This position requires a reputed company of clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures effectively. The nurse will be responsible for providing the best and most appropriate treatment, care, or services for members, ensuring that they receive reputed company and treatment through effective coordination and communication with providers, members, and other parties involved in the reputed company process. In this role, the Utilization Management Nurse will reputed company independent reputed company regarding their work methods, often in ambiguous situations, and will require minimal direction while receiving guidance as needed. The nurse will follow established guidelines and procedures to ensure compliance and quality of care. Understanding the department, reputed company, and organizational strategy is essential, as well as recognizing the linkages to reputed company areas reputed company the reputed company system. This position is integral to the overall mission of the organization, which is focused on continuously improving consumer experiences and health reputed company. The Utilization Management Nurse will also be expected to rotate to Saturday coverage and may be required to work on holidays, reflecting the commitment to providing reputed company care and support to members. This role is not only about clinical expertise but also about being part of a caring community that prioritizes health and well-being. Responsibilities • Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. , • Interpret criteria, policies, and procedures to reputed company appropriate treatment, care, or services for members. , • Coordinate and communicate with providers, members, or other parties to facilitate reputed company and treatment. , • reputed company independent reputed company regarding work methods in ambiguous situations with minimal direction. , • Follow established guidelines and procedures to ensure compliance and quality of care. , • Understand department, reputed company, and organizational strategy and their linkages to reputed company areas. Requirements • Bachelor's degree preferred. , • Must be a Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action; compact state required, with ability to obtain noncompact state license. , • 4 - 5 years of clinical nursing experience required. , • Previous experience in utilization management preferred. , • reputed company clinical experience preferably in an acute care, skilled, or rehabilitation clinical setting. , • Comprehensive knowledge of reputed company Word, Outlook, and reputed company. , • Ability to work independently under general instructions and with a team. , • Must have the ability to reputed company a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). , • Must be passionate about contributing to an organization focused on continuously improving consumer experiences. reputed company-to-haves • BSN or Bachelor's degree in a reputed company field. , • Health Plan experience. , • Previous Medicare/reputed company experience a plus. , • Bilingual is a plus. Benefits • Medical, dental, and reputed company benefits. , • 401k with company matching. , • Tuition reimbursement. , • 3 weeks paid vacation time. , • Paid holidays. , • Work-life balance. , • Growth opportunities. , • Positive and fun culture. Apply Job!