Utilization Management Nurse

Required Skills/Abilities: Strong knowledge of utilization management functions in value-based care, including data analysis, claims review, reimbursement practices, and medical records reviews. Thorough, in-depth knowledge of evidence-based practice, legal rules and regulations and best practices in healthcare Ability to effectively leverage business and organizational knowledge within and across functional areas Must possess a high degree of emotional intelligence and integrity, driven and focused work ethic Continuous desire to learn and embrace new methods; ability to adapt and be resilient. Self-starter with the ability to think creatively and work effectively Ability to build a relationship and work effectively with various seniorities and diverse populations. Excellent critical reasoning, decision-making, and problem-solving skills to make informed decisions and ensure effective resource utilization while maintaining quality patient care. Willingness and ability to travel, up to 20% Education and Experience: AA/AS degree in Nursing required; BA/BS degree in Nursing (BSN) or Healthcare Administration preferred A valid, active Registered Nurse (RN) license in state(s) of employment required A minimum of 3 years’, current direct utilization management required Work in an acute care facility, community-based clinic, public health department or specialization with the senior population preferred Proficient PC skills Fluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required

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