Utilization Management Nurse at Tacoma

Job Description

Utilization Management Nurse
Tacoma, WA; Burlington, WA; Lewiston, ID; Portland, OR; or Salt Lake City, UT

In this role, you will provide preauthorization review for clinical services to determine medical necessity of services for Regence members. The Utilization Management Nurse reviews pre-authorization requests for medical necessity and reviews clinical information for pre-certification and concurrent reviews, extending the length of stay as appropriate. Additionally, you will identify special care needs and make appropriate referrals to care management or other programs to collaborates on recommended outcomes. Responding in writing or telephonically to members and providers, in a professional and diplomatic manner, you will help ensure our members receive effective, integrated, medically necessary care.

Key Qualifications and Experience:

• Current, unrestricted license or certification as an RN or other applicable health care professional licensure
  
• Three years direct clinical care experience is required
  
• Two years experience in the health insurance industry in an applicable area is preferred
  
• Previous concurrent review, prior authorization, utilization management, or discharge planning experience preferred
  
• Computer Skills (Microsoft Office, Outlook, Internet, and typing skills) required. Familiarity with health care documentation systems a plus (i.e.: EPOCH, Clinical Care Advance, MedDecision)
  
• Knowledge of Milliman Care Guidelines preferred
  
• Strong verbal, written and interpersonal skills and strong customer-service skills, including courteous telephone etiquette
  
• Ability to interpret policies and procedures and communicate effectively
  
• Excellent documentation skills
  
• Ability to make decisions and exercise good judgment in a complex environment
  
• Superior organization and time management skills

Job Requirements

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. A drug screen and background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. Weve been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If youre seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambias portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.


Country: USA, State: Washington, City: Tacoma, Company: Cambia Health Solutions.