Utilization Management Nurse

Utilization Management Nurse

Employer: CenterWell. Become a part of our caring community The Utilization Management RN will collaborate with other health care givers in reviewing medical care and services. This review will involve evaluating actual and proposed care against established CMS Coverage Guidelines/NCQA review criteria. You will be part of a team that focuses on excellent service to others. You will report to a Utilization RN Manager. Use your skills to make an impact Required Qualifications - Active and unrestricted RN license with no disciplinary action - 5+ years of clinical RN experience - 5+ years of Acute Care experience in the Hospital ICU or ER settings - Prior clinical experience, managed care experience, DME, Florida Medicaid OR utilization management experience - Experience cross training and floating among teams - Available for On Call weekend/holiday rotation Preferred Qualifications - BSN or bachelor's degree in a related field - Active and unrestricted Compact Registered Nurse (RN) license with no disciplinary action (including Nevada) - Experience working within Florida Medicaid - Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures - Experience in utilization management within Insurance industry - Medicare Advantage, Medicare or Medicaid Experience - Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. - Bilingual in English and Spanish with the ability to read/write and speak in both languages Additional Information - Travel for offsite Orientation for 2 to 8 weeks - Travel to offsite meetings up to 6 times a year - Working hours are 9:00 am to 6:00 pm EST Preferred Candidate Locations: Daytona, FL, Louisville, KY, San Antonio, TX To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL conne