The Utilization Management Nurse will use his/her professional judgment to evaluate the request and ensure that services are appropriately approved, recognize care coordination opportunities and refer those cases to Population Health as needed. The Utilization Management Nurse will apply independent medical judgment to medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The Utilization Management Nurse will ensure that treatment delivered is appropriate and meets the Member's needs in the least restrictive, least intrusive manner possible. The Utilization Management Nurse will maintain current knowledge and understanding of and regularly apply the laws, regulations, and policies that pertain to the organizational business units and uses clinical judgment in their application.
This description provides a general overview of the position, recognizing that day to day duties of each individual in the position may vary based on personal experience, skills, supervision, cases and other factors.
*This is a contract role paid on 1099.
*You must have a Oregon RN license and be able to provide your own laptop for work.
* A quiet workspace/home office is required.
*Two years of recent managed care experience working as a UM Nurse is required.
Job Type: Contract
Pay: From $45.00 per hour
Standard shift:
Weekly schedule:
Experience:
- Interqual/MCG Guideline: 3 years (Required)
- Managed Care/Insurance Company: 3 years (Required)
- Medicaid population review: 2 years (Required)
License/Certification:
- RN License in Oregon (Required)
Work Location: Remote
Job Types: Full-time, Contract
Pay: $45.00 per hour
Expected hours: 40 per week
Medical Specialty:
Physical Setting:
Experience:
- UM Nursing-Health Plan: 3 years (Required)
- Behavioral health: 3 years (Preferred)
License/Certification:
- Oregon RN license (Required)
Work Location: Remote
