Utilization Management Nurse I

Healthcare Management Administrators; Bellevue (WA); Hybrid; USD 83,000 - 99,000; Full time

Benefits offered by this job

Generous total rewards package

Flexible schedules

401(k) retirement plan with company match

Wellness incentives

Job summary

A healthcare management organization is seeking a Utilization Management Nurse to oversee health service utilization while collaborating with external entities. This role requires an active LPN/RN license, and candidates should have clinical experience and proficiency in electronic health records. The organization promotes work-life balance and offers a comprehensive benefits package including remote work options.

Qualifications

• 1-3+ years of clinical nursing experience.
• Knowledge of Utilization Review processes preferred.
• Behavioral health experience preferred.

Responsibilities

• Collaborate with external entities for case specifics.
• Provide monitoring of member utilization.
• Evaluate services requested to meet health care needs.

Skills

Strong problem solving and critical thinking skills

Excellent, client-facing verbal and written communication skills

Proficiency with Electronic Health Records

Education

Associate's degree or equivalent professional experience

Active LPN/RN clinical license required

Tools

Microsoft Office applications (Outlook, Word, DOSS)

Job description

Overview

Base pay range: $83,000.00/yr - $99,000.00/yr

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. For four years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ. Our vision, ‘Proving What's Possible in Healthcare,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

What we are looking for: We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.

What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/

Role and Responsibilities

The Utilization Management Nurse collaborates with external entities such as Brokers, Group Contacts, and Stop Loss supports to provide updated information on case specifics within HIPAA regulations. The Utilization Management Nurse is responsible for efficient utilization of health services by providing monitoring of member utilization and claim patterns; and makes referrals to Case Manager nurses for ongoing case management for complex care. The Utilization Management Nurse does not provide nursing services to patients or members; HMA accepts licensed nurses who do not hold a compact license or WA state nursing license.

• Performs Utilization Management and applies first the terms of the SPD (Summary Plan Description), considering any benefit limitations/exclusions and PPO status of requesting provider/facility
• Reviews are conducted using approved criteria for appropriateness of services, setting/level of care and length of stay
• Provides ongoing review management of treatment progress as needed to provide personalized support and care coordination for complex, catastrophic or ongoing chronic medical conditions
• Evaluates services requested to meet an individual's health care needs, with the goal of providing personalized management to promote and ensure continuity of care coordination
• Other duties as assigned

Requirements

• Associate's degree or equivalent professional experience
• Active LPN/RN clinical license required
• 1-3+ years of clinical nursing experience
• Knowledge of Utilization Review processes (Preferred)
• Strong experience in clinical practice with diverse diagnoses
• Strong problem solving and critical thinking skills
• Excellent, client-facing verbal and written communication skills
• Behavioral health experience (Preferred)
• Ability to be self-motivated and self-directed
• Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skills
• Proficiency with Electronic Health Records, Microsoft Office applications (Outlook, Word, DOSS)

Compensation and Benefits

The base salary for this position in the greater Seattle area is $83,000-$99,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available.

Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.

In addition, HMA provides a generous total rewards package for full-time employees that includes:

• Seventeen (IC) days paid time off (individual contributors)
• Eleven paid holidays
• Two paid personal and one paid volunteer day
• Company-subsidized medical, dental, vision, and prescription insurance
• Company-paid disability, life, and AD&D insurances
• Voluntary insurances
• HSA and FSA pre-tax programs
• 401(k)-retirement plan with company match
• Annual $500 wellness incentive and a $600 wellness reimbursement
• Remote work and continuing education reimbursements
• Discount program
• Parental leave
• Up to $1,000 annual charitable giving match

Work, Life, and Wellness

HMA supports work-life balance with flexible schedules across time zones, remote work options or office-based work with amenities near Seattle. We emphasize career growth opportunities and a collaborative culture, plus in-person events throughout the year. We hire people from across the US (excluding Hawaii and the cities of Los Angeles and San Francisco). A background screen is required prior to employment. Protected Health Information (PHI) access is governed by standard policies and procedures. HMA is an Equal Opportunity Employer.

For more information about HMA, visit www.accesshma.com.

Seniorilty and Employment Type

• Seniority level: Associate
• Employment type: Full-time
• Job function: Other
• Industries: IT Services and IT Consulting

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