The Utilization Management Nurse is responsible for handling authorization requests, reviewing requests for medical necessity and plan coverage, managing provider communications, and ensuring accurate data entry of coding and provider information. This position requires knowledge of clinical terminology, basic nursing, attention to detail, and the ability to manage multiple tasks in a fast-paced environment.
As a registered nurse with an Illinois nursing license, you will work remotely to enhance the quality of member management, maximize both satisfaction and cost effectiveness, and assist in navigating the health care system as a collaborative health partner in their health care team. As an RN Case Manager, the RN will work closely with client and members alike to promote wellness, problem-solve, and assist members in realization of their personal health-care related goals.