Remote Utilization Management Registered Nurse, FL

✨ About The Role

- Utilization Management Nurse - Front End Review role involves utilizing clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations - Responsibilities include interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members - Conduct acute concurrent front-end reviews on Humana members to determine medical necessity using MCG criteria - Coordinate and communicate with providers, members, or other parties to facilitate optimal care, treatment, and discharge planning, including telephonic outreach - Requires making decisions regarding work methods, occasionally in ambiguous situations, and following established guidelines/procedures

⚡ Requirements

- Licensed Registered Nurse (RN) in Florida with 3 or more years of clinical experience, preferably in an acute care-inpatient hospital setting - Proficient in using MS Office, navigating multiple systems, and troubleshooting basic technical difficulties in a remote environment - Ability to work independently under general instructions and with a team - Strong general computer skills in an autonomous work setting