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Utilization Management Nurse

  • Location: Durham, 27707
  • Salary: 30.0
  • Job Type:Contract

Posted 10 days ago

Our Healthcare Insurance client is seeking a Utilization Management Nurse to join their team for a contract role!

Our client has over 5,000 employees and is the number 1 health insurer in the state of North Carolina, serving more than 3.89 million customers. Health care is changing, and our client is leading the way by providing innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs. Our client is a not-for-profit with headquarters in Durham, NC.

Position: Utilization Management Nurse
Term: 5 + Months
Location: Remote, USA - State of NC preferred, but may recruit within the approved states of NC, SC, Georgia, Florida, Maryland, Pennsylvania, Virginia. EST hour

Required Skills 

  • RN licensure, Compact licensure
  • Must have Licensure in one of the following states: NC, SC, GA, FL, MD, PA, VA.
  • RN preferred, LPNs considered
  • Candidates should have clinical experience, working in a hospital or other medical setting

Desired Skills 

  • UM experience highly preferred.

The Episodic Care Manager/UM Nurse is responsible for performing prior authorizations for continuity of care and in-network exceptions to assess, facilitate, and coordinate the delivery of care across the Health Care System. The Episodic Care Manager/UM Nurse also acts as a member advocate to promote and coordinate the delivery of quality, cost effective health care services based on medical necessity utilizing medical policy/contractual benefits. In addition, the Episodic Care Manager coordinates with providers and consumers to support the delivery of high quality care across the health care system.

****To be eligible to contract at this client you must be able to pass a drug test and criminal background check.