Remote Utilization Management Nurse

Arkansas Blue Cross Blue Shield; Eagle (ID); A distancia; USD 85.000 - 115.000; Jornada completa

Descripción de la vacante

Arkansas Blue Cross Blue Shield is seeking a qualified Utilization Management Nurse to perform clinical review of prior approvals, network exceptions, and benefit inquiries. You will assess medical necessity and promote quality care while controlling costs using evidence-based guidelines and corporate policies.

The role requires an active RN license, a Bachelor's degree preferred, and at least four years of clinical nursing experience in med-surg, ICU, or critical care.

Formación

• Bachelor's degree in Nursing preferred.
• RN license active in the relevant state(s) required.
• Minimum four years of clinical nursing in med-surg, ICU, or critical care.
• Utilization management/medical review experience preferred.
• Proficiency with basic Microsoft Office and multi-system navigation.

Responsabilidades

• Perform clinical review of prior approvals, network exceptions, benefit inquiries.
• Assess and evaluate medical necessity using evidence-based criteria and guidelines.
• Collaborate with providers and internal staff to promote quality and cost effective care.
• Document review cases and maintain compliance with URAC and state regulations.
• Promote cost containment and appropriate levels of care while ensuring patient safety.

Conocimientos

Interpersonal Relationship Management

Time Management

Critical Thinking

Prioritization

Educación

Registered Nurse license

Bachelor's degree in Nursing preferred

Herramientas

Microsoft Outlook

Microsoft Word

Microsoft SharePoint

Microsoft Excel

Descripción del empleo

Arkansas Blue Cross Blue Shield is seeking a qualified Utilization Management Nurse to perform clinical review of prior approvals, network exceptions, and benefit inquiries. You will assess medical necessity and promote quality care while controlling costs using evidence-based guidelines and corporate policies.

The role requires an active RN license, a Bachelor's degree preferred, and at least four years of clinical nursing experience in med-surg, ICU, or critical care.