Utilization Management Nurse

This is a fully remote position, open to applicants in Iowa.

📋 Description

• Engage with providers via phone to assess and pre-authorize requests for services such as hospital admissions, outpatient surgeries, diagnostic tests, and care.

• Evaluate requests in accordance with evidence-based guidelines.

• Confirm that care is appropriate, timely, and medically necessary.

• Manage multiple provider calls concurrently in a high-pressure environment.

• Collaborate closely with participants for referrals to case management and condition management services, following referral criteria and health plan regulations.

⛳️ Requirements

• Registered Nurse (RN) with clinical experience.

• Exceptional multitasking abilities.

• Clinical experience is preferred in areas such as Emergency Room (ER), Intensive Care Unit (ICU), mental health, orthopedics, and/or pain management.

• Bilingual candidates are preferred.

🏝️ Benefits

• Medical, Dental, and Vision Insurance.

• Flexible Spending Account or Health Savings Account (HSA).

• 401(k) plan with company matching.

• Profit-Sharing/Defined Contribution with a one-year waiting period.

• Paid Time Off (PTO) and Paid Holidays.

• Company-sponsored Short-Term and Long-Term Disability insurance.

• Maternity and Parental Leave.

• Subsidized Parking.

• Company-covered Term Life and Accidental Death Insurance.

• Daytime office hours.

• Weekends and holidays off.