✨ About The Role
- This position involves utilizing clinical experience to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members.
- The role requires gathering clinical information and applying appropriate clinical criteria to make coverage determinations.
- Communication with providers and other parties is essential to facilitate care and treatment for members.
- The job includes identifying members for referral opportunities to integrate with other products and services.
- The position operates within a 24/7 utilization management framework, requiring flexibility for weekend, holiday, and evening rotations.
âš¡ Requirements
- The ideal candidate will have over three years of experience as a Registered Nurse, demonstrating a strong clinical background.
- Candidates should possess an active and unrestricted RN licensure in their state of residence.
- Experience in acute or post-acute settings is essential, with at least one year of clinical experience required.
- Strong communication skills, both verbal and written, are necessary for effective collaboration with providers and other parties.
- The ability to multitask and adapt to a fast-paced, changing environment is crucial for success in this role.