Utilization Management Nurse

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

📋 Description

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

• Evaluate requests based on evidence-based guidelines.

• Ensure that care and medically necessary services are delivered at the appropriate time.

• Manage multiple provider calls in a dynamic, fast-paced environment.

• Collaborate closely with participants to facilitate referrals to case management and condition management services in accordance with referral criteria and health plan guidelines.

⛳️ Requirements

• Must possess an RN license and have clinical experience.

• Exceptional multitasking abilities are required.

• Experience in ER, ICU, mental health, orthopedics, and/or pain management is preferred.

• Bilingual candidates are preferred.

🏝️ Benefits

• Medical, Dental, Vision Insurance.

• Flex Spending or HSA.

• 401(k) with company match.

• Profit-Sharing/Defined Contribution (with a 1-year waiting period).

• PTO/Paid Holidays.

• Company-paid Short-Term and Long-Term Disability.

• Maternity Leave/Parental Leave.

• Subsidized Parking.

• Company-paid Term Life/Accidental Death Insurance.

• Daytime office hours.

• Weekends and holidays off.