What are the responsibilities and job description for the Utilization Management Nurse position at hc360?
Utilization Management Nurse
Location: Onsite in Dubuque, IA. Also accepting remote applicants.
We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, and prefers working in a professional office setting with daytime office hours and weekends/holidays off.
This position is responsible for working telephonically with providers to evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc. Review requests and match up to an evidence-based guideline to ensure proper care and ensure the right service is happening at the right time and is medically necessary. In this position you will be handling multiple provider phone calls at any given time and need to be able to handle a very fast paced environment. You will also work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines.
Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably in ER, ICU, mental health, orthopedics, and/or pain management. Bilingual is also preferred.
Full-Time Benefits - Most benefits start day 1
- Medical, Dental, Vision Insurance
- Flex Spending or HSA
- 401(k) with company match
- Profit-Sharing/Defined Contribution (1-year waiting period)
- PTO/Paid Holidays
- Company-paid ST and LT Disability
- Maternity Leave/Parental Leave
- Subsidized Parking
- Company-paid Term Life/Accidental Death Insurance