RN Coordinator Utilization Management

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

Job summary

An established industry player in healthcare services is seeking a dedicated Registered Nurse to join their team. This role offers the chance to work remotely while making a positive impact on patient care and outcomes. You will be responsible for reviewing authorization requests, evaluating clinical appropriateness, and collaborating with various departments to enhance operational processes. With opportunities for career advancement and a supportive work environment, this position is perfect for those looking to grow in their nursing career while contributing to comprehensive care management. Join a team where your skills and expertise can truly make a difference!

Qualifications

• 4+ years of clinical healthcare experience as a Registered Nurse.
• Current registered nurse licensure in Wisconsin is required.

Responsibilities

• Review authorization requests for medical necessity and benefit eligibility.
• Collaborate with departments to develop operational processes.

Skills

Clinical Healthcare Experience

Utilization Management

Patient Care

Collaboration Skills

Education

Associate Degree in Nursing

Bachelor of Science in Nursing

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:

1. Opportunity for career advancement and growth within the organization
2. Work remotely from home with reliable internet access
3. Supportive and collaborative work environment
4. Chance to make a positive impact on patient care and outcomes
5. Involvement in comprehensive care management assessments

What to Expect (Job Responsibilities):

1. Review submitted authorization requests for medical necessity, appropriateness of care, and benefit eligibility
2. Evaluate and process prior authorization requests/referrals from both contracted and non-contracted providers
3. Provide education on utilization management activities to members, caregivers, and providers
4. Collaborate with other departments to develop operational processes within the organization
5. Complete assessments and plans of care for members, including treatment plans and self-management strategies

What is Required (Qualifications):

1. Associate Degree in Nursing, required
2. Minimum of four (4) years of clinical healthcare experience as a Registered Nurse (RN)
3. Current registered nurse licensure in Wisconsin required
4. Experience in insurance, managed care, and utilization management preferred
5. Bachelor of Science in Nursing preferred

How to Stand Out (Preferred Qualifications):

1. Experience in insurance, managed care, and utilization management
2. Strong knowledge of utilization management criteria and processes