Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely from home with reliable internet access
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and outcomes
- Involvement in comprehensive care management assessments

What to Expect (Job Responsibilities):
- Review submitted authorization requests for medical necessity, appropriateness of care, and benefit eligibility
- Evaluate and process prior authorization requests/referrals from both contracted and non-contracted providers
- Provide education on utilization management activities to members, caregivers, and providers
- Collaborate with other departments to develop operational processes within the organization
- Complete assessments and plans of care for members, including treatment plans and self-management strategies

What is Required (Qualifications):
- Associate Degree in Nursing, required
- Minimum of four (4) years of clinical healthcare experience as a Registered Nurse (RN)
- Current registered nurse licensure in Wisconsin required
- Experience in insurance, managed care, and utilization management preferred
- Bachelor of Science in Nursing preferred

How to Stand Out (Preferred Qualifications):
- Experience in insurance, managed care, and utilization management
- Strong knowledge of utilization management criteria and processes

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