The Utilization Management Nurse 2-Tuscaloosa, AL utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Utilization Management Nurse -Tuscaloosa, AL uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

• Must live in Tuscaloosa, AL area
• Licensed Registered Nurse (RN) in the Alabama
• 2+ years of prior clinical experience preferably in an acute care hospital, skilled or rehabilitation clinical setting
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and with a team
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• This role is considered patient facing and is part of Client/Senior Bridge’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

• Education: BSN or Bachelor’s degree in a related field
• Previous experience in utilization management
• Health Plan experience
• Previous Medicare/Medicaid Experience a plus
• Call center or triage experience
• Bilingual is a plus

Additional Information
Hours for this role are: Monday-Friday 8am-5pm CST

This role will require you to be onsite at a local medical facility for part of the day meeting with member’s to review their medical necessity and the remainder of the day will be work at home.

This is a Work at Home role located in Tuscaloosa, AL