This position is with Catalyst Pain Solutions. The Nurse position utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. The hours for this position are 8:00AM-5PM MST.
Fundamental components include but are not limited to:
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management.
-Active, unrestricted Registered Nurse (RN) License required
-3+ years of clinical experience required
-Utilization Management (UM) experience required
-Managed Care experience preferred
-Exemplary clinical documentation skills; critical thinking skills
-Must be able to demonstrate computer proficiency skills and work independently as a self starter in a fast paced production and metrics driven environment
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
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