Schedule:

This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage.

Position Summary

Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.

Key Responsibilities

• Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care. 
• Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs. 
•  Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization. 
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. 
• Meet set productivity and quality expectations as established by UMNC. 

Required Skills and Abilities:

• Effective verbal and written communication skills. 
•  Proficiency with computer skills, including navigating multiple systems and keyboarding. 
• Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment. 
• Capacity to sit for extended periods, talk on the telephone, and type on the computer. 

Work Location:

This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed. 

Required Qualifications:

Preferred Qualifications

• Utilization review experience
• Experience with LTAC, skilled rehab, or home health
• Managed Care experience

Education

• Minimum Diploma RN acceptable or Associate degree in Nursing required
• BSN preferred