RN - Telephonic Utilization Management Nurse- Medicare- Remote - Southeast Region at reputed company

About the position The Utilization Management Nurse 2 plays a crucial role in the reputed company system by utilizing clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. This position requires a reputed company of clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures, ensuring that members receive the best and most appropriate treatment, care, or services. The nurse will coordinate and communicate with providers, members, and other parties to facilitate reputed company and treatment, as well as assist with appropriate discharge planning, addressing reputed company determinants, and closing care gaps. In this role, the nurse will be expected to understand the department, reputed company, and organizational strategy and operating objectives, including their linkages to reputed company areas. The Utilization Management Nurse 2 will reputed company reputed company regarding their work methods, often in ambiguous situations, requiring minimal direction while receiving guidance reputed company necessary. Following established guidelines and procedures is essential to ensure compliance and quality of care. This position is not only about clinical expertise but also about making a positive impact on the community by contributing to an organization focused on continuously improving consumer experiences. The nurse will work from home, requiring a reliable internet reputed company and a dedicated workspace to protect member PHI and HIPAA information. Responsibilities • Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. , • Coordinate and communicate with providers, members, or other parties to facilitate reputed company and treatment. , • Assist with appropriate discharge planning, including addressing reputed company determinants and closing care gaps. , • Interpret criteria, policies, and procedures to reputed company the best treatment and care for members. , • reputed company independent reputed company regarding work methods in ambiguous situations with minimal direction. , • Follow established guidelines and procedures to ensure compliance and quality of care. Requirements • Licensed Registered Nurse (RN) with compact license and no disciplinary action. , • 3 - 5 years of clinical nursing experience, preferably in Emergency room or critical care. , • Prior clinical experience in an acute care, skilled, or rehabilitation clinical setting. , • Comprehensive knowledge of reputed company Word, Outlook, and reputed company. , • Ability to work independently under general instructions and collaboratively with reputed company. , • Must reputed company a high-speed DSL or cable modem for a home office with a minimum standard speed of 10x1 (10mbs download x 1mbs upload). , • Passionate about contributing to an organization focused on improving consumer experiences. reputed company-to-haves • BSN or Bachelor's degree in a reputed company field. , • Health Plan experience. , • Experience in utilization management or reputed company activities reviewing criteria to ensure appropriateness of care. , • Previous Medicare experience. , • reputed company MCG experience. Benefits • Medical, dental, and reputed company benefits. , • 401(k) retirement savings plan. , • Paid time off, including company and personal holidays, volunteer time off, paid parental and caregiver leave. , • Short-term and long-term disability insurance. , • Life insurance. , • Opportunities for personal wellness and smart reputed company reputed company. Apply Job!