Location: Lancaster, SC
Location Type: Lancaster – Remote
Additional Location: AL; AK; AZ; AR; CA; CO; CT; DE; DC; FL; GA; HI; ID; IL; IN; IA; KS; KY; LA; ME; MD; MA; MI; MN; MS; MO; MT; NE; NV; NH; NJ; NM; NY; NC; ND; OH; OK; OR; PA; RI; SD; TN; TX; UT; VT; VA; WA; WI;
The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- Registered Nurse license; preferred compact
- Clinical experience in an acute care, skilled or rehabilitation setting
- Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care
- Comprehensive knowledge of Microsoft Word, Outlook and Excel and ability to easily navigate through multiple applications
- Ability to work independently under general instructions and with a team
- Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required
- Health Plan experience
- Previous Medicare/Medicaid Experience
- Call center or triage experience
- Bilingual is a plus
This is a weekend position. Fri, Sat, Sun, 7a-7p, hours subject to change based on business needs.
As part of our hiring process for this opportunity, we will be using an interviewing technology called Montage Text/ Voice Messaging to enhance our hiring and decision-making ability. This allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward, you will receive a text correspondence inviting you to participate in a Text Message screen. You should anticipate this interview to take about 5 to 10 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to the next round of interviews.
If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
Scheduled Weekly Hours
Search by License
Search Jobs by State
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- West Virginia