Remote Medicare Advantage Utilization Management Nurse

Job ID: Available for Members

Location: Nationwide

Compensation: To Be Discussed

Staff Reviewed: Thu, Jul 23, 2020

Job Category: Customer Service, Healthcare, Insurance

Remote Level: Partially Remote

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Some College

Job Summary

An insurance agency needs applicants for an opening for a Remote Medicare Advantage Utilization Management Nurse.

Must be able to:

  • Maintain a thorough understanding of Health Plan operations and business unit processes
  • Coordinate investigation and resolution of complex grievance and appeal issues
  • Develop a working familiarity with applicable regulatory and accreditation requirements

Qualifications Include:

  • Registered Nurse License, active and unencumbered state license in the state where job duties are performed
  • Associates degree in Nursing required
  • Three years of clinical practice nursing experience in medical-surgical nursing, surgical nursing, intensive care or critical care nursing
  • Two years of CMS member services, prior authorizations, appeals/grievances or claims experience