Utilization Management Nurse

Job Description

Utilization Management Nurse 
REMOTE

RN license number must valid for Arkansas
Can work on holidays and during the weekend

Utilization Management: Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery; documenting all relevant and specific information; and screens, prioritizes and organizes determination requests according to mandates and standards. Promotes appropriate care and quality toward cost effective and cost containment measures based on evidence.

Knowledge: Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery; and enterprise procedures, policies and contracts.Other duties as assigned. Schedule Notes:

 Skills: Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding 4. Experience in utilization management and/or medical review preferred. Specialized Knowledge & Skills
Ability to prioritize and make sound nursing judgments through critical thinking
Excellent verbal and written communication skills
Ability to build collaborative relationships
Attention to details
Ability to interpret complex documentation