Utilization Management Nurse

About the role

We are seeking a Utilization Management Nurse to join our team in Dubuque, IA, with the option to work remotely. The ideal candidate will thrive in a fast-paced environment, enjoy making a difference for patients, and prefer working in a professional office setting with daytime office hours and weekends/holidays off.

Responsibilities

• Work telephonically with providers to evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc.
• Review requests and match them 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.
• Handle multiple provider phone calls at any given time in a fast-paced environment.
• Work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines.

Requirements

• Strong multitasking skills
• RN and clinical experience, preferably in ER, ICU, mental health, orthopedics, and/or pain management
• Bilingual (preferred)

Qualifications

• Current RN license in good standing
• Experience in utilization management or related field

Skills

• Excellent communication skills
• Strong problem-solving abilities
• Proficiency in healthcare coding and billing

Benefits

• Full-Time Benefits
• 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