Remote Utilization Management RN

Arkansas Blue Cross Blue Shield; Provo (UT); A distancia; USD 70.000 - 90.000; Jornada completa

Descripción de la vacante

Arkansas Blue Cross and Blue Shield is seeking an experienced Utilization Management Nurse (RN) to perform clinical reviews of prior approvals, network exceptions, and benefit inquiries. The role focuses on medical necessity, evidence-based care, and cost containment with a remote work option across multiple states.

The ideal candidate is an RN with 4+ years of clinical practice in medical-surgical, ICU, or critical care areas, licensed in the relevant jurisdiction, and with familiarity in

Formación

• Registered Nurse (RN) with active, current, unrestricted license in the state(s) where duties are performed.
• Bachelor's degree in Nursing preferred.
• Minimum four years of clinical practice nursing experience in medical-surgical, surgical, ICU or critical care.
• Experience in utilization management and/or medical review preferred.
• Proficient with basic computer skills and MS Office (Word, Excel, Outlook).
• Ability to prioritize and make sound nursing judgments through critical thinking.

Responsabilidades

• Conduct clinical review of prior approvals, network exceptions, and benefit inquiries.
• Assess medical necessity through evidence-based criteria and guidelines.
• Promote cost-effective and appropriate levels of care while ensuring patient safety.
• Collaborate with providers and internal staff to improve care quality and accessibility.
• Document clinical reviews and decisions accurately; adhere to policies and standards.
• Supports work from home setup and remote collaboration across states.

Conocimientos

Data Analysis

Interpersonal Relationship Management

Microsoft Outlook

Microsoft SharePoint

Microsoft Word

Time Management

Collaboration with providers

Educación

Bachelor's degree in Nursing

RN license

Herramientas

Microsoft Outlook

Microsoft SharePoint

Microsoft Word

Descripción del empleo

Arkansas Blue Cross and Blue Shield is seeking an experienced Utilization Management Nurse (RN) to perform clinical reviews of prior approvals, network exceptions, and benefit inquiries. The role focuses on medical necessity, evidence-based care, and cost containment with a remote work option across multiple states.

The ideal candidate is an RN with 4+ years of clinical practice in medical-surgical, ICU, or critical care areas, licensed in the relevant jurisdiction, and with familiarity in