Utilization Review RN: Clinically Driven Case Manager

Prominence Health Plan; Reno (NV); Sur place; USD 80 000 - 110 000; Plein temps

Avantages offerts par ce poste

Loan Forgiveness Program

Paid Time Off

Excellent Medical, Dental, Vision

Résumé du poste

Prominence Health Plan is hiring a Utilization Review nurse to review clinical cases for UM decisions in NV/FL/TX. The UR RN may coordinate resources, consult Medical Director, and document findings for care optimization.

Eligible professionals include RN/LPN/LVN with active licenses and UR/Case Management background. Strong English communication and documentation skills are essential.

Qualifications

• Graduation from an accredited nursing program; Bachelor's preferred.
• Current, unrestricted RN/LPN/LVN license in NV, FL, or TX or eligibility.
• Minimum three years Utilization Review/Case Management experience.
• Experience with InterQual or Milliman guidelines is preferred.

Responsabilités

• Review clinical cases for appropriateness against criteria and evidence.
• Coordinate resources within and outside the benefit plan for outcomes.
• Prepare timely verbal and written case reports for oversight.

Connaissances

English proficiency

Attention to detail

Communication skills

Multitasking

Bilingual English/Spanish

Formation

Bachelor's degree in nursing

RN license in NV/FL/TX or eligible

Description du poste

Prominence Health Plan is hiring a Utilization Review nurse to review clinical cases for UM decisions in NV/FL/TX. The UR RN may coordinate resources, consult Medical Director, and document findings for care optimization.

Eligible professionals include RN/LPN/LVN with active licenses and UR/Case Management background. Strong English communication and documentation skills are essential.