Job Duties Performs activities that support the clinical review and timely resolution of requests for prior authorization, concurrent review, and retrospective reviews in a manner that is compliant with URAC and NCQA standards. The UM role requires that the incumbent utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services.
Ability to prioritize and meet deadlines
Demonstrates dependability and reliability to work independently resulting in timely completion of projects
Ability to negotiate with varied parties to achieve desired goals
Ability to read, understand, and discuss complex medical documentation
Ability to provide innovative ideas and methods for providing needed care in alternative settings
Demonstrates interpersonal skills required to assure professional, effective interaction with all customers, actively listens to understand the perspective of others
Demonstrates ability to handle difficult situations diplomatically, encourages diverse opinions and expression of constructive disagreement
Models and supports effective team interactions
Demonstrates organizational, analytical and problem-solving ability
Previous experience in a medical management or managed care setting with prior authorization experience preferred
Proficiency with computer based programs such as Microsoft Word, Excel and SharePoint
Graduate of Accreditation Commission for Education in Nursing or Commission on Collegiate Nursing Education accredited school of nursing, or three years related professional nursing experience; BSN preferred
License Must have a current and valid license as a Registered Nurse from the Indiana Professional Licensing Agency
Additional Salary Information: RN Sign-on bonus available
We live our mission, every day. Service to the community is at the cornerstone of everything we do and our foundation for exceptional care.
Our employees build strong teams that deliver exceptional care through empathy, communication and collaboration. By putting the patient first, we create an environment that promotes health and well-being.
Every employee plays a vital role in our mission. We embrace diversity and the learning and innovation that comes with it.