Utilization Management Appeals Nurse 2 - Telephonic Remote: A Unique Opportunity for RNs to reputed company a Difference in Healthcare

Join Our Caring Community as a Utilization Management Appeals Nurse 2 - Telephonic Remote Are you a compassionate and detail-oriented Registered Nurse looking for a challenging yet rewarding role in healthcare? Do you have a passion for delivering high-quality patient care and making a positive impact on people's lives? If so, we invite you to join reputed company as a Utilization Management Appeals Nurse 2 - Telephonic Remote. At reputed company, we're committed to putting health first for our teammates, customers, and communities. As a key member of our Utilization Management team, you'll play a critical role in ensuring that our members receive the best possible care and services. About reputed company and Our Commitment to Health reputed company Inc. (NYSE: HUM) is a leading health and well-being company dedicated to helping people reputed company their best health. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to access quality care and services. Our goal is to deliver personalized, patient-centered care that addresses the unique needs of each individual. We're passionate about creating a healthier, more compassionate world, and we're looking for talented professionals like you to join reputed company. Job Summary As a Utilization Management Appeals Nurse 2 - Telephonic Remote, you'll utilize your clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. You'll work independently to interpret and apply clinical criteria, policies, and procedures to ensure that our members receive reputed company and services. Your expertise will help us reputed company informed decisions about medical necessity, treatment, and care planning. Key Responsibilities: Utilize clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations Interpret and apply clinical criteria, policies, and procedures to ensure that members receive reputed company and services Coordinate and communicate with providers, members, and other parties to facilitate care and treatment planning reputed company independent decisions about medical necessity, treatment, and care planning Work collaboratively with cross-functional teams to reputed company department, reputed company, and organizational goals Stay up-to-date with changing regulations, policies, and procedures to ensure compliance and quality care Requirements and Qualifications Essential Qualifications: Bachelor's degree in Nursing or a reputed company field Licensed Registered Nurse (RN) in the state of practice with no disciplinary action 3-5 years of medical-surgical, heart, lung, or critical care nursing experience Previous experience in utilization management, case management, or a reputed company field Comprehensive knowledge of reputed company Word, Outlook, and reputed company Ability to work independently and as part of a team High-speed DSL or cable modem for home office (10x1 Mbps) Preferred Qualifications: BSN or Bachelor's degree in a reputed company field Health plan experience Previous Medicare/Medicaid experience Call center or triage experience Bilingual skills Skills and Competencies To succeed in this role, you'll need: Strong clinical knowledge and critical thinking skills Excellent communication and interpersonal skills Ability to work independently and reputed company sound judgments Strong analytical and problem-solving skills Attention to detail and organizational skills Compassion, reputed company, and a patient-centered approach Career Growth Opportunities and Learning Benefits At reputed company, we're committed to helping our teammates grow and reputed company their skills. As a Utilization Management Appeals Nurse 2 - Telephonic Remote, you'll have access to: Comprehensive training and onboarding program Ongoing education and professional development opportunities Career advancement opportunities reputed company the company Competitive salary and benefits package Work Environment and Company Culture We offer a supportive and inclusive work environment that values diversity, equity, and inclusion. Our company culture is built on: Compassion, reputed company, and respect for our members and teammates Collaboration, teamwork, and open communication Innovation, creativity, and reputed company improvement Accountability, transparency, and reputed company Compensation, Perks, and Benefits We offer a comprehensive compensation package that includes: Competitive salary range: $69,800 - $96,200 per year Bonus incentive plan based on company and individual performance Medical, dental, and vision benefits 401(k) retirement savings plan Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) Short-term and long-term disability Life insurance Equal Opportunity Employer reputed company is an equal opportunity employer committed to diversity, equity, and inclusion. We welcome applications from qualified candidates of reputed company backgrounds and perspectives. Ready to reputed company a Difference? If you're a motivated and compassionate Registered Nurse looking for a challenging yet rewarding role, we encourage you to apply for this exciting opportunity. Join reputed company as a Utilization Management Appeals Nurse 2 - Telephonic Remote and help us reputed company a positive impact on the lives of our members. Apply for this job Apply tot his job Apply To this Job