Remote RN: Utilization Management & Care Quality

Arkansas Blue Cross Blue Shield; Little Rock (AR); A distancia; USD 66.000 - 84.000; Jornada completa

Descripción de la vacante

Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews for prior approvals and case management while promoting quality and cost containment. The role requires an RN with current licensure and a minimum of four years' nursing experience in relevant areas.

The position is remote within Arkansas and selected nearby states, with standard office-based policies and adherence to state regulations and URAC standards.

Formación

• Bachelor's degree in Nursing preferred.
• RN license active and in good standing in relevant jurisdiction.
• Minimum four years of clinical nursing experience in medical-surgical, surgical, ICU or critical care.

Responsabilidades

• Collaborates with healthcare providers and internal staff to promote quality of care and cost effectiveness.
• Conducts and monitors clinical review cases to ensure medical necessity and documents information per mandates.
• Performs duties as assigned while adhering to policies, URAC standards and regulations.
• Promotes evidence-based, cost containment measures and maintains patient safety.

Conocimientos

Active Listening

Analytical Decision Making

Critical Thinking

Data Analysis

Educational Development

Interpersonal Relationship Management

Microsoft Outlook

Microsoft SharePoint

Microsoft Word

Oral Communications

Problem Sensitivity

Sound Judgment

Team Development

Time Management

Written Communication

Educación

Bachelor's degree in Nursing

Herramientas

Microsoft Word

Microsoft Outlook

Microsoft Excel

Microsoft SharePoint

Descripción del empleo

Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews for prior approvals and case management while promoting quality and cost containment. The role requires an RN with current licensure and a minimum of four years' nursing experience in relevant areas.

The position is remote within Arkansas and selected nearby states, with standard office-based policies and adherence to state regulations and URAC standards.