Utilization Management Nurse Consultant - Fully Remote

The Muse - Des Moines, IA

Job Title: Utilization Management Nurse Consultant - Fully Remote

Position: Clinical Nurse - Utilization Management

Job Type: Full Time

Pay: $26.01 - $74.78

Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30-6:00pm MST

Work Type: Remote

Location

Address:

City: Des Moines

State: IA

ZIP Code:

Job Responsibilities

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Applies clinical experience and skills in assessing, planning, implementing, coordinating, monitoring and evaluating options for healthcare services/benefits.
Gathers clinical information and applies clinical criteria, guidelines, policies, procedures, and clinical judgment for coverage determinations.
Communicates with providers to facilitate care and treatment.
Identifies members for referral opportunities to integrate with other products and services.
Promotes quality effectiveness of healthcare services and benefit utilization.
Consults with internal and external constituents for coordination and administration of the utilization/benefit management function.
Functions in a clinical telephone queue for prior authorization review.
Works with providers to secure additional information for prior authorization review.

Required Skills

Core Skills

Clinical judgment
Utilization management
Communication
Assessment and planning skills
Prior authorization processing

Preferred Skills

Managed Care experience
High volume clinical call center experience
Remote work experience

Requirements

Experience: 1 year UM, concurrent review or prior authorization; 5 years of clinical experience; 5 years of demonstrated independent decision making.

Education: Associate's nursing degree (RN) minimum required, Bachelor's degree preferred.

License & Certification:

Registered Nurse unrestricted license in state of residence
Multi-state/compact privileges

Schedule:

Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30-6:00pm MST
Weekend/holiday coverage occasionally required
100% participation required during first 3 weeks of training.

COVID-19 Requirements: Not Specified

Benefits

Affordable medical plan options
401(k) plan including matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Supplemental Pay

Eligible for bonus, commission or short-term incentives in addition to base pay.

Special Notes

Commitment to fostering a workplace where every colleague feels valued and that they belong.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.