Utilization Management Nurse

The role

You will work by phone with providers to review and pre-certify requests such as hospital stays, outpatient surgeries and tests. 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 such as hospital stays, outpatient surgeries, outpatient tests and care
• Review requests and match them to evidence-based guidelines to confirm medical necessity and the right care at the right time
• Handle multiple provider phone calls at once in a fast-paced environment
• 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

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
• Most benefits start day 1

About the company

Cottinghambutlerinsuranceservicesinc is hiring a Utilization Management Nurse. The posting describes a health plan review role.