Utilization Management Nurse

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

📋 Description

• Engage with providers over the phone to assess and pre-certify requests, including hospital admissions, outpatient surgeries, outpatient tests, and care.

• Evaluate requests based on evidence-based guidelines.

• Ensure the delivery of appropriate care, medically necessary services, and timely access to the right services.

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

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

⛳️ Requirements

• Registered Nurse (RN) with clinical experience.

• Excellent multitasking abilities.

• Clinical experience, preferably in 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 or Health Savings Account (HSA).

• 401(k) plan with company matching.

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

• Paid Time Off (PTO) and Paid Holidays.

• Company-funded Short-Term and Long-Term Disability coverage.

• Maternity Leave and Parental Leave.

• Subsidized Parking.

• Company-paid Term Life and Accidental Death Insurance.

• Most benefits commence on day one.