The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services, discharges and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action at an on-site facility.

Responsibilities

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for our Medicare members.

• Coordinate and communicate with providers, members, case managers PCP or other parties to facilitate appropriate discharge planning, assist with social determinants and closing gaps to facilitate optimal care and treatment
• Identify barriers to discharge and unavoidable readmissions
• Understands department, segment, and organizational strategy and operating objectives, including how they interrelate to each area
• Works independently, makes appropriate decisions, requires minimal direction and seeks guidance where needed
• Evaluate and refer to other programs available to Member
• Follows established guidelines/procedures

Required Qualifications

• RN License without restrictions in Fl or Compact State license.
• Located near West Palm hospitals and facilities including HCA JFK Medical Center.
• 2 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Ability to work independently under general instructions and with a team
• Independent critical thinking skills
• Strong Written and verbal communication skills
• Valid Driver’s License and/or dependable transportation necessary
• Travel to Hospital/Provider for on-site reviews to assist Members
• This role is considered patient facing. If selected for this role, you will be required to meet criteria to be on-site with Providers/Hospitals/Health Care Facilities including Flu vaccine, Covid Vaccine, TB Test, Immunizations (Hep B, MMR, Varicella)

Preferred Qualifications

• BSN or Bachelor's degree in a related field
• Previous experience in discharge planning, utilization management or case management a plus
• Health Plan experience
• Previous Medicare Experience a plus
• Bilingual is a plus

Additional Information:

This position supports the Florida Region Medicare Health Service Organization

Must be able to work 8:30 am-5pm EST M-F

85-90% onsite and the remaining time is remote/WAH.

Scheduled Weekly Hours

40

Additional Information

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours

40