Remote RN: Utilization Management & Clinical Review

Arkansas Blue Cross Blue Shield; Accident (AR); Teletrabalho; USD 85 000 - 110 000; Tempo integral

Resumo da oferta

Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and inpatient/outpatient procedures. The role ensures medical necessity and cost-effective care through adherence to guidelines and policies.

The ideal candidate holds an active RN license, a BSN preferred, and at least four years of clinical practice in medical-surgical, ICU, or related areas.

Qualificações

• Registered Nurse with active, current license in the relevant jurisdiction.
• BSN preferred and at least 4 years of clinical nursing experience.
• Experience in utilization management or medical review is preferred.
• Proficiency with Microsoft Office and navigating multiple systems.

Responsabilidades

• Conduct clinical review of prior approvals, network exceptions, benefit inquiries, and admissions.
• Assess medical necessity using evidence-based criteria, guidelines and policies.
• Promote cost containment and appropriate care through informed decisions.
• Collaborate with providers and internal staff to ensure quality of care.

Conhecimentos

Nursing

Critical Thinking

Clinical Review

Formação académica

Bachelor's degree in Nursing

Ferramentas

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft SharePoint

Descrição da oferta de emprego

Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and inpatient/outpatient procedures. The role ensures medical necessity and cost-effective care through adherence to guidelines and policies.

The ideal candidate holds an active RN license, a BSN preferred, and at least four years of clinical practice in medical-surgical, ICU, or related areas.