**Description** 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. **Responsibilities** **Creating Healthy Communities is good for the Soul. Join Us!** 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 + Coordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gaps + 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 **Required Qualifications** + Active RN license in the state(s) in which the nurse is required to practice + Prior clinical experience preferably in an acute care, post-acute, skilled or rehabilitation clinical setting + Must have good typing skills and proficiency using MS Office Word, Excel and Outlook + Ability to work independently under general instructions and with a team + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + 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 10x1 (10mbs download x 1mbs upload) is required **Preferred Qualifications** + Education: BSN or Bachelor's degree in a related field + Health Plan experience + Previous Medicare/Medicaid Experience a plus + Call center or triage experience + Previous experience in utilization management strongly preferred + Previous experience with Milliman (MCG) + Discharge planning and/or home health or rehab **Scheduled Weekly Hours** 40 <>
Categories
• Financial Services