Utilization Management RN III

About the role

Medica is a nonprofit health plan serving communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We are a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration.

Responsibilities

• Review and document member case history in compliance with policies and procedures for approval of member coverage.
• Analyze trends through feedback from case reviews and recommend revisions to medical policies and utilization management/clinical appeals policies.
• Interface with members, providers, clinics, medical directors, intake staff, case managers, and other departments within Medica.

Requirements

• Bachelor's degree or equivalent work experience in a related field.
• 5+ years of work experience beyond degree.
• Active, unrestricted RN license.

Qualifications

• Experience with appeals.
• Utilization Management experience.
• Knowledge of regulatory requirements specific to UM processes.
• Self-motivated, autonomous worker with the ability to work independently and collaboratively.
• Detail-oriented with strong organizational skills.
• Technology-savvy; ability to work within multiple computer applications.
• Demonstrated clinical assessment skills with the ability to think critically and make evidence-based decisions.

Skills

• Strong communication skills.
• Ability to work independently and collaboratively.
• Attention to detail.
• Organizational skills.
• Technical proficiency.
• Clinical assessment skills.

Benefits

This position is a Remote role. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.

Pay

The full salary grade for this position is $70,200 - $120,400. The typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.

Schedule

This position is a Remote role.

Additional Information

Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services, and many other benefits to support our employees. The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Equal Opportunity Employer

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.