Utilization Management Nurse I (Remote eligible)

Wellmark Blue Cross and Blue Shield and its subsidiaries provide health coverage to more than 2 million members in Iowa and South Dakota. And through the Blue Cross Blue Shield Association, Wellmark is part of a trusted national network that insures more than 100 million people. That's nearly 1/3 of all Americans. Wellmark offers flexible benefit designs, competitive prices, and a large selection of providers. Nearly all physicians and hospitals in Iowa and South Dakota participate with Wellmark, and the Blue Cross and Blue Shield Association provides extensive national and international coverage. *Wellmark Blue Cross and Blue Shield is An Independent Licensee of the Blue Cross and Blue Shield Association serving Iowa and South Dakota.

Are you a dedicated, compassionate and detail-oriented health care professional with the ability to adapt to change and anticipate needs? Are you organized, inquisitive, and thrive in a collaborative setting, while exhibiting independent and critical thinking where resourcefulness is key? Are you motivated and inspired by the opportunity to utilize your clinical expertise in a fast-paced production environment with quality goals? Do you enjoy a team-centric environment where relationship building and strong communication skills are crucial to success? If so, apply today!

As a Utilization Management (UM) Nurse, you will provide UM services, transition of care and support to members and health care providers. You will utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, medical necessity criteria (InterQual), and benefit information to provide consultation and responses to UM requests. You will proactively assess and assist members to help move them through the continuum of care by utilizing services and resources efficiently. You will be part of a multidisciplinary team to continuously look for ways to improve processes and maximize health dollars for our members.