RN Utilization Management — Weekend Coverage + $5k Premium

Arkansas Blue Cross and Blue Shield; Little Rock (AR); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Salary premium

Job summary

Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to review prior approvals, network exceptions, and benefit inquiries for various lines of business. The role assesses medical necessity and coordinates care with evidence-based criteria, including weekend coverage outside normal hours.

The position requires an active RN license, a Bachelor's degree in Nursing preferred, and at least four years of clinical experience in relevant areas; utilization management

Qualifications

• Bachelor's degree in Nursing preferred.
• Registered Nurse (RN) with an active state license required.
• Minimum four years of clinical practice nursing experience (medical-surgical, surgical, ICU/CCU).
• Experience in utilization management and/or medical review required.

Responsibilities

• Collaborates with providers and internal staff to promote quality of care, cost effectiveness and accessibility.
• Conducts and monitors clinical reviews to ensure medical necessity for inpatient and outpatient services, procedures, and out-of-network care; documents information and prioritizes requests.
• Adheres to licensure, policies and URAC standards; makes evidence-based decisions for appropriate level of care and patient safety.
• Promotes cost containment measures based on evidence and current enterprise procedures.

Skills

Active Listening

Analytical Decision Making

Critical Thinking

Data Analysis

Educational Development

Interpersonal Relationship Management

Microsoft Outlook

Microsoft SharePoint

Microsoft Word

Oral Communications

Problem Sensitivity

Sound Judgment

Team Development

Time Management

Written Communication

Education

Bachelor's degree in Nursing (preferred)

RN license active in state of practice

Tools

Microsoft Outlook

Microsoft SharePoint

Microsoft Word

Job description

Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to review prior approvals, network exceptions, and benefit inquiries for various lines of business. The role assesses medical necessity and coordinates care with evidence-based criteria, including weekend coverage outside normal hours.

The position requires an active RN license, a Bachelor's degree in Nursing preferred, and at least four years of clinical experience in relevant areas; utilization management