Remote RN: Utilization Management & Quality Care

Arkansas Blue Cross Blue Shield; United States; Remote; USD 90.000 - 130.000; Vollzeit

Zusammenfassung

Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and inpatient/outpatient services to ensure medical necessity and evidence-based care.

Requires a Bachelor’s degree in Nursing, an active RN license, and at least 4 years of clinical experience (medical-surgical, ICU or critical care); experience in utilization management preferred. Strong communication and Microsoft Office skills are essential.

Qualifikationen

• Bachelor’s degree in Nursing preferred.
• RN license active and in good standing in relevant state.
• Minimum four (4) years of clinical nursing experience in medical-surgical, surgical, ICU or critical care.
• Experience in utilization management and/or medical review preferred.

Aufgaben

• 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 of services and documentation.
• Performs other duties as assigned.
• Adheres to licensure scope, policies and regulations to ensure compliance and patient safety.
• Promotes cost containment and evidence-based care.
• Keeps current with medical procedures and contracts.
• Handles incoming/outgoing calls from mandated sources.

Kenntnisse

Active Listening

Analytical Decision Making

Critical Thinking

Data Analysis

Interpersonal Relationship Management

Microsoft Outlook

Microsoft Word

Oral Communications

Written Communication

Time Management

Team Development

Problem Sensitivity

Sound Judgment

Ausbildung

Bachelor’s degree in Nursing

Tools

Microsoft Office

Jobbeschreibung

Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and inpatient/outpatient services to ensure medical necessity and evidence-based care.

Requires a Bachelor’s degree in Nursing, an active RN license, and at least 4 years of clinical experience (medical-surgical, ICU or critical care); experience in utilization management preferred. Strong communication and Microsoft Office skills are essential.