Apply

Utilization Management Nurse

Posted 4 months ago

View full description

💎 Seniority level: Middle, 3 years

📍 Location: Arcadia, CA, PST, NOT STATED

💸 Salary: 40 - 40 USD per hour

🔍 Industry: Managed care

🗣️ Languages: English

⏳ Experience: 3 years

🪄 Skills: LeadershipProject ManagementData AnalysisPeople ManagementProject CoordinationCross-functional Team LeadershipOperations ManagementCommunication SkillsAnalytical SkillsCollaborationMicrosoft Excel

Requirements:
  • Bachelor's degree from a four-year college and/or a professional certification preferred.
  • Minimum 3 years of referrals and utilization management experience.
  • HMO experience is preferred.
  • General knowledge of medical terminology and coding (ICD-10, CPT/HCPCS).
  • Strong verbal and written communication skills.
  • Time management skills.
  • Computer literacy, specifically in Word, Outlook, and Excel.
Responsibilities:
  • Responsible for regional care management programs (inpatient and ambulatory).
  • Ensure care management activities meet regulatory requirements and are efficient and effective.
  • Supervise Nurse Reviewers, including their training, performance evaluation, and scheduling.
  • Support compliance in processing referrals and ensure adherence to policies.
  • Participate in quality improvement initiatives by analyzing processes.
  • Communicate relevant issues and maintain professional relationships with health plans and providers.
Apply

Related Jobs

Apply

📍 United States

🔍 Healthcare

🏢 Company: Dane Street, LLC

  • Holds an unrestricted LVN/RN license from an accredited program.
  • Minimum 2 years of clinical nursing experience.
  • 1 year of experience in Utilization Management.
  • Proficient in written and spoken communication.
  • Skilled in Microsoft tools (Word, Excel, PowerPoint, Outlook).
  • Organizational skills and attention to detail.

  • Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines.
  • Examine and evaluate patient records for quality of care and necessity of services.
  • Offer clinical expertise to non-clinical staff.
  • Manage clinical details within medical management platforms.
  • Stay updated with regulatory requirements and state standards.
  • Communicate with management teams, physicians, and Medical Director to foster patient care.

LeadershipMicrosoft AccessCross-functional Team LeadershipOperations ManagementCommunication SkillsAnalytical SkillsCollaborationMicrosoft ExcelProblem SolvingMicrosoft OfficeAttention to detailOrganizational skillsTime ManagementWritten communicationMultitaskingMicrosoft Office Suite

Posted 14 days ago
Apply
Apply
🔥 Utilization Management Nurse I
Posted about 1 month ago

📍 Iowa, South Dakota

🔍 Insurance

  • 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 that includes direct clinical care.
  • Experience in a utilization management or health insurance setting is beneficial.
  • Strong verbal and written communication skills.
  • Commitment to service excellence and member advocacy.
  • Ability to organize and manage multiple priorities.
  • Strong technical skills, particularly with Microsoft Office and clinical documentation platforms.

  • Provide members and health care providers with timely prior approval for services and procedures by obtaining necessary medical information.
  • Assist in precertification and continued stay reviews for members in healthcare facilities.
  • Collaborate with healthcare providers to ensure timely discharge planning.
  • Process utilization management requests by interpreting medical policy and benefit information.
  • Collaborate with interdisciplinary care teams to meet member needs.
  • Document review processes and decisions accurately and timely.
  • Comply with regulatory standards and internal guidelines.

Communication SkillsAnalytical SkillsCollaborationProblem SolvingOrganizational skillsCritical thinking

Posted about 1 month ago
Apply
Apply

📍 United States

💸 45000 - 70000 USD per year

🔍 Healthcare, Insurance

🏢 Company: Dane Street, LLC

  • Proficient in written and spoken communication.
  • Ability to maintain professional communication with physicians and clients.
  • Skilled in handling multiple tasks and adapting in a dynamic setting.
  • Strong organizational skills and attention to detail.
  • Adept at solving complex problems.
  • Experienced with Microsoft tools like Word, Excel, PowerPoint, and Outlook.
  • Background in medical or clinical practice through education or professional experience.
  • Holds an unrestricted LVN/RN license from an accredited program.

  • Conduct assessments of medical services to validate their appropriateness using established criteria.
  • Examine patient records to verify the quality of care and necessity of services.
  • Provide clinical expertise and reference support for non-clinical staff.
  • Manage clinical details within medical management platforms.
  • Stay updated on regulatory prerequisites for utilization review.
  • Apply clinical reasoning to evidence-based guidelines.
  • Communicate with management, physicians, and the Medical Director to foster patient care.

LeadershipMicrosoft AccessCross-functional Team LeadershipCommunication SkillsAnalytical SkillsCollaborationMicrosoft ExcelProblem SolvingOrganizational skills

Posted about 2 months ago
Apply
Apply

📍 United States

💸 45000 - 70000 USD per year

🔍 Healthcare

🏢 Company: Dane Street, LLC

  • Proficient in both written and spoken communication.
  • Capable of maintaining professional communication with physicians and clients.
  • Skilled at handling multiple tasks and adjusting in a dynamic office setting.
  • Possesses a keen organizational sense and pays attention to details.
  • Adept at resolving intricate problems.
  • Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
  • Holds an unrestricted LVN/RN license from an accredited vocational nursing program or nursing degree from an accredited college.
  • Minimum 2 years clinical nursing experience and 1 year of Utilization Management experience.

  • Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines.
  • Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
  • Offer clinical expertise to non-clinical staff members.
  • Manage essential clinical details within various medical management platforms.
  • Foster efficient patient care by effectively communicating with management, physicians, and others.

LeadershipData AnalysisMicrosoft AccessCommunication SkillsAnalytical SkillsCollaborationMicrosoft ExcelMicrosoft Office

Posted about 2 months ago
Apply