Remote RN: Utilization Management & Clinical Review

Arkansas Blue Cross Blue Shield; Minneota (MN); A distancia; USD 70.000 - 100.000; Jornada completa

Descripción de la vacante

Arkansas Blue Cross Blue Shield seeks an Utilization Management Nurse to perform clinical reviews for prior approvals, network exceptions, and inpatient/outpatient procedures, ensuring medical necessity with evidence-based criteria.

The role emphasizes cost containment, quality care, and adherence to corporate guidelines, with RN licensure and a BSN preferred. Remote work is available from multiple states.

Formación

• At least four years of clinical nursing experience in medical-surgical or critical care.
• Experience in utilization management or medical review preferred.
• Active RN license in good standing; BSN preferred.

Responsabilidades

• Collaborates with providers and staff to promote quality of care and cost effectiveness.
• Conducts clinical reviews to ensure medical necessity for inpatient/outpatient services and procedures.
• Documents all information; adheres to URAC standards and state regulations.
• Stays current with procedures, policies, and enterprise contracts.

Conocimientos

Data Analysis

Interpersonal Relationship Management

Microsoft Outlook

Microsoft SharePoint

Microsoft Word

Time Management

Educación

Bachelor's degree in Nursing

RN license in good standing

Herramientas

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft SharePoint

Descripción del empleo

Arkansas Blue Cross Blue Shield seeks an Utilization Management Nurse to perform clinical reviews for prior approvals, network exceptions, and inpatient/outpatient procedures, ensuring medical necessity with evidence-based criteria.

The role emphasizes cost containment, quality care, and adherence to corporate guidelines, with RN licensure and a BSN preferred. Remote work is available from multiple states.