[Hiring] Utilization Management Nurse @West Coast Consulting

Role Description

Utilization Management Nurse

• REMOTE
• RN license number must be valid for Arkansas
• Can work on holidays and during the weekend
• Utilization Management:
  • Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery.
  • Documents all relevant and specific information.
  • Screens, prioritizes, and organizes determination requests according to mandates and standards.
  • Promotes appropriate care and quality toward cost-effective and cost containment measures based on evidence.
• Knowledge:
  • Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery, and enterprise procedures, policies, and contracts.
• Other duties as assigned.
• Schedule Notes:

Qualifications

• Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook.
• Ability to navigate multiple systems and keyboarding.
• Experience in utilization management and/or medical review preferred.

Requirements

• Ability to prioritize and make sound nursing judgments through critical thinking.
• Excellent verbal and written communication skills.
• Ability to build collaborative relationships.
• Attention to details.
• Ability to interpret complex documentation.