Utilization Management Prior Authorization Nurse

Hewlett Packard Enterprise – Enterprise Services (HPE ES) is a leading global technology services provider delivering out sourcing services and business solutions to clients around the world. HPE ES founded the information technology outsourcing industry nearly a half-century ago and today delivers one of the industry’s broadest portfolios of information technology, applications and business process outsourcing services available on the market today.

Temporary with benefits role

Utilization Mgmt (UM)/Prior Authorization Nurse:

The UM Nurses primary purpose is to conduct medical service clinical reviews based on established regulatory and nationally recognized clinical criteria.

ESSENTIAL FUNCTIONS

  • May Performs initial telephone and/or facsimile screening
  • Provides excellent communication and customer service
  • Proficient in critical thinking and problem solving
  • Follows predefined UM processes, procedures, and policies in context within the UM workflow
  • Provides appropriate clinical issue resolution and escalation of issues when needed
  • Ability to multi-task with several initiatives while exceeding performance expectations

Required Skills:

(Knowledge, Skills, Abilities)

Medicaid Experience preferred

Healthcare/Insurance Experience preferred

  • Minimum of Associate Degree in Nursing is required.

RN (State of KY) – must have active license

  • Proficient typing skills.
  • Proficient PC skills with experience in MS Office; Word, Excel, Outlook.
  • Excellent customer service skills.
  • Excellent oral, written and interpersonal communication skills.
  • Knowledge of UM/Prior Authorization processes preferred.
  • Strong organizational and time management skills are essential.
  • Must understand the technical working environment and associated systems and have strong problem solving skills.

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