Utilization Management Nurse (RN) – Remote Option

Medical Associates; Dubuque (IA); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health Insurance

401k with matching

PTO 24 days/year

FSA (Medical & Dependent Care)

Life and Disability Insurance

Job summary

Medical Associates is seeking an Utilization Management Nurse to join our Health Care Services team. The role involves reviewing requests for approvals, applying screening criteria to ensure appropriate and cost-effective care, and coordinating with the health plan to determine benefit eligibility.

Primary schedule is Monday–Friday, 8:00am–5:00pm, 40 hours/week with flexibility. Training is in-person in Dubuque, IA, with potential for work-from-home after training.

Qualifications

• Valid RN nursing license is required.
• Three to five years of similar or related experience.

Responsibilities

• Review provider or member requests for approvals of procedures, medications, or services.
• Apply established screening criteria to ensure appropriate, cost-effective care.
• Facilitate options to meet health needs while reducing duplication of care.
• Review hospital and skilled admissions to justify continued care per guidelines.
• Coordinate with claims and health plan staff to determine benefit eligibility.

Skills

Utilization management

RN license

Healthcare experience

Communication

Collaborative work

Education

Registered Nurse license

Job description

Medical Associates is seeking an Utilization Management Nurse to join our Health Care Services team. The role involves reviewing requests for approvals, applying screening criteria to ensure appropriate and cost-effective care, and coordinating with the health plan to determine benefit eligibility.

Primary schedule is Monday–Friday, 8:00am–5:00pm, 40 hours/week with flexibility. Training is in-person in Dubuque, IA, with potential for work-from-home after training.