Telephonic Skilled Nursing Facility UM Nurse - Knoxville TN (office-based)
- Knoxville, TN
The Skilled Nursing Facility Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Skilled Nursing Facility Utilization Management Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Skilled Nursing Facility Utilization Management Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- Associates Degree
- Licensed Registered Nurse (RN) in the state of Tennessee with no disciplinary action.
- Previous experience in utilization management required
- 3+ years of prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Ability to work independently under general instructions and with a team
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- 3+ years of utilization management or skilled nursing facility experience
- Education: BSN or Bachelor's degree in a related field
- Health Plan experience
- Previous Medicare/Medicaid Experience a plus
- Call center or triage experience
- Bilingual is a plus
This position is located in Knoxville TN so candidates must live within a reasonable commuting distance to the office.
Scheduled Weekly Hours
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