Job Description
Job Summary:
We are seeking a Pre-Access Utilization Management Registered Nurse to join a remote team supporting a leading health insurance provider. In this role, you will be responsible for reviewing and collaborating with healthcare professionals to assess patient care requests, such as surgeries, procedures, and hospital admissions. You'll work closely with providers to ensure that these services meet medical necessity criteria, playing a key role in maintaining high standards of patient care.
This position requires a strong attention to detail, excellent communication skills, and the ability to work both independently and as part of a team. The ideal candidate will be adaptable and able to navigate the dynamic nature of healthcare, ensuring alignment with company policies on confidentiality and privacy.
Key Responsibilities:
Assess patient care requests for medical services, such as surgeries, procedures, and hospital admissions.
Collaborate with doctors and other healthcare providers to ensure the medical necessity of services.
Maintain confidentiality and adhere to privacy policies.
Provide clear and accurate communication, both written and verbal, with healthcare teams and providers.
Stay informed on the medical plan and benefit templates to ensure proper utilization management.
Work Schedule Options:
Wednesday to Saturday (5x8) - starting as early as 7 AM in your local time zone.
Thursday to Saturday (4x10) - starting as early as 7 AM in your local time zone.
This is a remote position, open to candidates from any time zone.
Required Qualifications:
Valid RN License in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, DC, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, or Washington.
4-5 years of remote Utilization Management experience with a health insurance provider (no third-party companies).
Experience using Milliman Care Guidelines (MCG).
Proficiency with Google Suite (Google Sheets, Calendar, etc.).
Comfortable using a Macbook and navigating a remote work environment (including setting up a workstation and using a VPN).
Strong critical thinking skills with the ability to independently troubleshoot issues.
This role is crucial for ensuring effective use of healthcare resources while maintaining the highest standards of patient care. If you're a detail-oriented, proactive Registered Nurse with a passion for making a meaningful impact in the healthcare system, we encourage you to apply!
Employment Type: Full-Time
Salary: $ 30.00 42.00 Per Hour
Job Tags
Hourly pay, Full time, Local area, Saturday,