Utilization Management (UM) Integration Nurse Remote

The UM Integration Nurse will work as part of the Care and Case Management team, focusing on projects and work that integrate Utilization Management (UM) with Care and Case Management (CCM). This role is ideal for a nurse who can effectively bridge these two critical areas. Responsibilities include communicating and coordinating with facilities, performing benefit verification, conducting care coordination calls, and working on transplant coordination. The nurse will help members navigate complex medical conditions, partner with local providers, coordinate with internal and external resources, and serve as an escalation point. They will also assist the clinical team with day-to-day work and direct patient care, while displaying a focus towards continuous improvement and suggesting new ideas. Responsibilities may shift over time depending on CCM and/or UM program needs.