Utilization Management Nurse

The role

You will work by phone with providers to review and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests and care. You will match each request to an evidence-based guideline to confirm it is medically necessary, and refer participants to case management and condition management services.

What you will do

• Work telephonically with providers to evaluate and pre-certify requests
• Review requests and match them to evidence-based guidelines
• Confirm the right service is given at the right time and is medically necessary
• Handle multiple provider phone calls at the same time
• Refer participants to case management and condition management services according to referral criteria and health plan guidelines

Required qualifications

• RN license
• Clinical experience
• Strong multitasking skills
• Ability to work in a very fast-paced environment

Nice to have

• Clinical experience preferably in ER, ICU, mental health, orthopedics, and/or pain management
• Bilingual

Benefits

• Medical, dental and vision insurance
• Flex Spending or HSA
• 401(k) with company match
• Profit-sharing/defined contribution (1-year waiting period)
• PTO and paid holidays
• Company-paid short-term and long-term disability
• Maternity and parental leave
• Subsidized parking
• Company-paid term life and accidental death insurance

Before you apply

• Most benefits start on day 1

About the company

Cottingham & Butler sells a promise to help clients through life's toughest moments. The company is focused on growth and on hiring, training and developing strong professionals.