Our mission is Better Health. Our passion is helping others.

What’s Your Why?

Are you looking for a career opportunity that will help you grow personally and professionally?
Do you have a passion for helping others achieve Better Health?
Are you ready to join a growing team that shares your mission?

Why Join Our Team At Better Health Group, it’s our commitment, our passion, and our culture that sets us apart. Our Team Members make a difference each and every day! They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients. We don’t just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive, and start living your purpose at Better Health Group.

Position Objective

The Utilization Management Nurse is responsible for managing requests providing a multi-faceted approach to managing requests for medical services while ensuring the services are medically appropriate and necessary. This role requires a multi-faceted approach, utilizing evidence-based clinical guidelines and input from healthcare providers. The incumbent will report to the Dir Utilization Mgmt (or similar role) and will work towards achieving high-quality, cost-efficient medical outcomes for patients requiring in-patient care and outpatient procedures.

Responsibilities

Assess each request for medical services, considering factors such as medical necessity, appropriateness, and adherence to evidence-based clinical guidelines
Utilize evidence-based clinical guidelines to make informed decisions regarding the approval or denial of requested medical services
Collaborate with healthcare providers to gather input and seek their expertise in making utilization management decisions
Communicate with healthcare providers, patients, and other stakeholders to gather necessary information, clarify any discrepancies, and provide updates on requested services
Ensure compliance with regulatory requirements and internal policies to ensure all activities comply with regulatory requirements
Monitor and track the utilization of medical services to identify trends, patterns, and opportunities for improvement and identify areas where cost-efficiency and quality of care can be optimized
Collaborate with internal teams to develop and implement strategies for optimizing medical outcomes and cost-efficiency to meet organizations goals
Provide education and support to healthcare providers regarding utilization management processes and guidelines
Participate in quality improvement initiatives related to utilization management
Contribute to the development, identify areas for improvement, and implement changes to enhance the overall quality of care
Maintain accurate and up-to-date detailed records of all utilization management activities
Additional duties as assigned

Position Requirements/ Skills

Registered Nurse (RN) license in good standing within state of practice
Bachelor's degree in Nursing or a related field, preferred
2 years of experience in Utilization Management
Previous training and demonstrated competence in negotiations, Quality Assurance, and Case Management outcomes
Demonstrated ability to solve complex, multifaceted, and emotionally charged situations
Strong knowledge of evidence-based clinical guidelines and medical terminology
Excellent critical thinking and decision-making skills
Effective communication and interpersonal skills
Ability to work independently and collaboratively in a fast-paced environment
Proficiency in using computer systems and software for documentation and data analysis
Proficient with Google Suite (Drive, Docs, Sheets, Slides) and Microsoft Office (Word, Excel, PowerPoint) for real-time collaboration

Physical Requirements

Ability to remain in a stationary position, often standing or sitting for prolonged periods of time
Communicating with others to exchange information
Repeating motions that may include the wrist, hands, and/or fingers
Assessing the accuracy, neatness, and thoroughness of work assigned
Must be able to lift at least 15lbs at times

Key Attributes/ Skills

Has a contagious and positive work ethic, inspires others, and models the behaviors of core values and guiding principles
An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments
Is able to work within our Better Health environment by facing tasks and challenges with energy and passion
Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals
Demonstrated ability to handle data with confidentiality
Ability to work cross-functionally with multiple teams; ability to work independently with minimal supervision
Excellent organizational, time-management, and multi-tasking skills with strong attention to detail
Excellent written and verbal communication skills; must be comfortable communicating with providers and patients
Strong interpersonal and presentation skills
Strong critical thinking and problem-solving skills
Must be results-oriented with a focus on quality execution and delivery
Appreciation of cultural diversity and sensitivity toward target patient population

Compensation & Benefits

We offer competitive compensation and comprehensive benefits package

Competitive base salary with bonus potential upon placement/retention
Medical, dental, vision, disability and life
401k, with employer match
Paid time off
Paid holidays

USD $63,650.00 - USD $85,000.00 /Yr.

Better Health Group jobs

Utilization Management Nurse