Remote RN Utilization Management Coordinator (Wisconsin)

Network Health WI; Menasha (WI); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Network Health WI is seeking an RN Coordinator for Utilization Management to evaluate authorization requests for medical necessity and appropriateness of care. This role allows for home office work but requires occasional travel to the corporate office in Menasha for training and other purposes.

Ideal candidates will have at least an Associate Degree in Nursing and four years of experience in healthcare. This position includes responsibilities like reviewing guidelines for payments and providing education regarding processes.

Qualifications

• Bachelor of Science in Nursing preferred.
• Associate Degree in Nursing required.
• Current registered nurse licensure in Wisconsin required.
• Minimum 4 years clinical experience as a Registered Nurse.

Responsibilities

• Evaluate and process prior authorization requests from providers.
• Document utilization management communication accurately.
• Educate members and providers on usage management processes.
• Collaborate with departments to enhance operational processes.
• Identify candidates for Case Management intervention.

Skills

Clinical health care experience

Utilization management

Insurance knowledge

Education provision

Education

Bachelor of Science in Nursing

Associate Degree in Nursing

Job description

Network Health WI is seeking an RN Coordinator for Utilization Management to evaluate authorization requests for medical necessity and appropriateness of care. This role allows for home office work but requires occasional travel to the corporate office in Menasha for training and other purposes.

Ideal candidates will have at least an Associate Degree in Nursing and four years of experience in healthcare. This position includes responsibilities like reviewing guidelines for payments and providing education regarding processes.