Remote RN Utilization Management Nurse

Arkansas Blue Cross; United States; Remote; USD 66,000 - 84,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to perform clinical reviews for medical necessity across various services. The role involves weekend coverage and work from home within Arkansas and several western states.

The ideal candidate holds an RN license, a nursing degree, and at least four years of clinical practice in relevant areas with utilization management experience. A premium is added to base salary for qualifying employees.

Qualifications

• Bachelor's degree in Nursing preferred.
• RN license with active state license in good standing required.
• Minimum four years' clinical practice nursing in med-surg/surgical/ICU/critical care.
• Experience in utilization management and/or medical review required.
• Employees meeting qualifications for this role with this schedule will receive a $5,000 premium added to base salary.

Responsibilities

• Collaborates with healthcare providers and internal staff to promote quality of care, cost effectiveness, accessibility and appropriateness of service levels.
• Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery; documents all relevant information; screens, prioritizes and organizes requests.
• Practices nursing within licensure scope and adheres to policies, regulations, URAC standards; making decisions based on facts to ensure compliance, appropriate level of care, and patient safety.
• Promotes appropriate care and quality toward cost effective and cost containment measures based on evidence.
• Provides primary utilization management review and communication for both scheduled workdays during the regular workweek AND scheduled weekend period.
• Remains current with up-to-date medical and surgical procedures, products, healthcare services and drugs; enterprise procedures and contracts.
• Works incoming and outbound calls and queues from multiple sources within mandated requirements.

Skills

Oral Communication

Written Communication

Attention to Detail

Microsoft Office

Critical Thinking

Interpersonal Relationships

Time Management

Education

Bachelor's degree in Nursing

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Microsoft SharePoint

Job description

Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to perform clinical reviews for medical necessity across various services. The role involves weekend coverage and work from home within Arkansas and several western states.

The ideal candidate holds an RN license, a nursing degree, and at least four years of clinical practice in relevant areas with utilization management experience. A premium is added to base salary for qualifying employees.