Utilization Review RN — Case Management & Outcomes

Prominence Health; Reno (NV); Presencial; USD 85.000 - 100.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Loan Forgiveness Program

Generous Paid Time Off

Excellent Medical, Dental, Vision

401(K) with company match

SoFi Student Loan Refinancing Program

Descripción de la vacante

Prominence Health is recruiting a Utilization Review Nurse to review clinical cases and coordinate care within a value-based care model. The UR Nurse collaborates with medical leadership to ensure appropriate services while maintaining efficient utilization.

Requires RN/LPN/LVN licensure in NV/TX/FL or US territory, with 3+ years UR/Case Management experience and InterQual/Milliman knowledge being a plus. Strong communication and analytical skills are essential for success.

Formación

• Graduation from an accredited nursing education program; BSN preferred.
• Current, unrestricted RN/LPN/LVN license in NV, FL, or TX or territory.
• Minimum 3 years Utilization Review/Case Management experience.
• Knowledge of InterQual criteria and Milliman Care Guidelines preferred.
• Proficient in English with strong written and verbal communication.

Responsabilidades

• Review clinical requests for medical services and consult with Medical Director on cases needing expertise.
• Coordinate resources within and outside the benefit plan to optimize clinical and financial outcomes.
• Maintain accurate records and provide timely verbal and written reports.
• Assist in notification processes for non-certifications when appropriate.

Conocimientos

English proficiency

Communication skills

Data analysis

Report writing

Empathetic, caring listener

Educación

Bachelor’s degree in Nursing

Advanced degrees (MBA/ MPH) - a definite plus

Herramientas

MS Office

Spell out clinical decision processes

Descripción del empleo

Prominence Health is recruiting a Utilization Review Nurse to review clinical cases and coordinate care within a value-based care model. The UR Nurse collaborates with medical leadership to ensure appropriate services while maintaining efficient utilization.

Requires RN/LPN/LVN licensure in NV/TX/FL or US territory, with 3+ years UR/Case Management experience and InterQual/Milliman knowledge being a plus. Strong communication and analytical skills are essential for success.