Utilization Manager, Registered Nurse
United States
- Eligibility
- RNUtilization ManagementUtilization ReviewCase Management
Posted Jul 23
What the listing says
Role
- Term
- Permanent
- Setting
- Case Management
- Accepts
- RN
Ratio not posted. Ask in the interview.
Pay
About this role
Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective. Works under general supervision.
Sourced from a public job board.
Requirements
- RN
- Nurse Licensure Compact (NLC)
- Bachelor's degree in nursing
- Associate Degree in Nursing
- Nurse Licensure Compact (NLC)
- Managed care organization experience
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- Medicare regulations
- Medicaid regulations
- Medicaid health insurance
- Centers for Medicare and Medicaid Services (CMS)
Benefits
- Paid parental leave
Place
- City
- United States
How this role fits you
About the employer
Worth asking
We can’t answer these from the listing we have. Good ones to ask a recruiter or in the interview.
- Can you walk me through differentials?
- What should I expect for shifts, weekly hours, weekend, holiday, call, and rotation?
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?