Registered Nurse - Utilization Management (30958)

Posted: 04/05/2021

Our Des Moines client is seeking Utilization Management Registered Nurses to join their team on a contract basis. Qualified candidates will utilize clinical skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. Apply today if this is the right position for you!

Responsibilities:

  • Review clinical information and policies to determine whether services can be approved or will eventually be denied
  • Manage network participation, care with specialty networks, care with providers, and transfer to alternative levels of care using knowledge of benefit plan
  • Recommend services utilizing care alternatives available within the community and nationally
  • Identify potentially unnecessary services and care delivery settings and recommend alternatives, if appropriate
  • Examine clinical programs to identify members for specific case management and/or disease management activities or intervention by utilizing established screening criteria
  • Conduct admission review, post-discharge calls, and discharge planning
  • Collaborate with healthcare providers in reviewing actual and proposed medical care and services against established client coverage guidelines review criteria
Requirements:
  • Flexibility, professionalism, and clinical knowledge are critical
  • Active RN license
  • 3+ years of clinical experience in a variety of clinical settings (operating room, acute care, medical-surgical nursing)
  • Strong computer skills with Microsoft Office and electronic charting and documentation systems
  • Familiarity with ICD-9, HCPC, CPT
Preferred Qualifications:
  • Bachelor's degree in nursing
  • Certified Professional Coder (CPC) or Utilization Management (UM) certification
  • Experience in utilization management in a clinical or health insurance setting with a diverse medical background
  • Experience interpreting health care benefits
Hours:
  • 8:00 AM - 5:00 PM 
  • Monday - Friday

Position Type: Full-Time

Salary Range: $50,000-$100,000