Utilization Management RN - Remote, Multi-State

Arkansas Blue Cross Blue Shield; Minnesota; Remote; USD 85,000 - 110,000; Full time

Job summary

Arkansas Blue Cross Blue Shield seeks a Utilization Management Nurse to perform clinical reviews for prior approvals, network exceptions, and inpatient/outpatient services from home. You will assess medical necessity using evidence-based criteria and contribute to cost containment while ensuring quality care.

Requirements include an active RN license in good standing, a Bachelor's degree in Nursing preferred, and at least four years of medical-surgical or critical care nursing experience, with

Qualifications

• RN license in good standing in the relevant jurisdiction
• Bachelor's degree in Nursing preferred
• Minimum four years of clinical practice nursing experience in medical-surgical, surgical, ICU or critical care

Responsibilities

• Perform clinical review of prior approvals, network exceptions, benefit inquiries, inpatient and outpatient services
• Assess medical necessity using evidence-based criteria and guidelines
• Promote quality care and cost containment through evidence-based practice
• Documentation of relevant information and adherence to regulations and policies
• Work from home within Arkansas, WA, OR, UT, ID, ND, or MN

Skills

Interpersonal relationship management

Time management

Critical thinking

Ability to navigate multiple systems

Education

Bachelor's degree in Nursing (preferred)

Registered Nurse license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft SharePoint

Job description

Arkansas Blue Cross Blue Shield seeks a Utilization Management Nurse to perform clinical reviews for prior approvals, network exceptions, and inpatient/outpatient services from home. You will assess medical necessity using evidence-based criteria and contribute to cost containment while ensuring quality care.

Requirements include an active RN license in good standing, a Bachelor's degree in Nursing preferred, and at least four years of medical-surgical or critical care nursing experience, with