Job Description:

• Review and assess clinical information to support coverage determinations
• Apply clinical guidelines, policies, and sound judgment across the care continuum
• Collaborate with providers and care teams to coordinate treatment plans
• Identify opportunities to enhance quality, efficiency, and member outcomes
• Refer members to additional programs and services as appropriate
• Serve as a clinical resource within utilization/benefit management

Requirements:

• Active, unrestricted RN license in state of residence
• 3+ years of RN experience
• 1+ year Med/Surg experience
• Proficiency with Microsoft Office (Outlook, Teams, Excel)
• Willingness to work required schedule post-training
• Prior Authorization or Utilization Management experience preferred
• Managed care experience preferred
• MedCompass experience preferred
• Ambulatory surgery background preferred
• BSN preferred (Associate’s required)

Benefits:

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility