RN Utilization Management Specialist

Univera Healthcare; Buffalo (NY); Hybrid; USD 62,000 - 118,000; Full time

Job summary

Univera Healthcare in Buffalo, NY is seeking a Utilization Management Nurse to coordinate and monitor the utilization of behavioral health or physical health services for members, ensuring compliance with regulatory and policy standards. The role requires an Associate degree, NYS RN license, and at least 3 years of clinical UM experience; Bachelor’s degree preferred.

You will collaborate with case management, providers, and the Medical Director, and may participate in on-call rotations.

Qualifications

• Associates degree and NYS RN license required. Bachelors degree preferred.
• Minimum of three years of clinical experience; Utilization Management experience preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Experience interpreting managed care benefits and government contracts preferred.

Responsibilities

• Performs pre-service, concurrent and post-service reviews to determine medical necessity.
• Plans and documents utilization management activities.
• Collaborates with providers to ensure no gaps in care.
• Acts as liaison to the provider community and explains UM processes.
• Maintains compliance with regulatory and accrediting standards.

Skills

Communication skills

Team collaboration

Multitasking

Education

Associates degree

NYS RN license

Bachelors degree preferred

Tools

Microsoft Office

Job description

Univera Healthcare in Buffalo, NY is seeking a Utilization Management Nurse to coordinate and monitor the utilization of behavioral health or physical health services for members, ensuring compliance with regulatory and policy standards. The role requires an Associate degree, NYS RN license, and at least 3 years of clinical UM experience; Bachelor’s degree preferred.

You will collaborate with case management, providers, and the Medical Director, and may participate in on-call rotations.