RN Utilization Management

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here. Job Summary Utilization Management Nurse performs clinical review of prior approvals, network exceptions, benefit inquiries, inpatient medical/surgical admissions and outpatient procedures for providers, and/or other contracted lines of business. This role assesses and evaluates the efficiency and appropriateness of services for medical necessity through interpretation and review with evidenced-based criteria, clinical guidelines, corporate guidelines and policies and mandates and standards. Incumbent also facilitates and promotes appropriate care and quality toward cost effective and cost containment measures based on evidence. Requirements EDUCATION Bachelor's degree in Nursing preferred. LICENSING/CERTIFICATION Registered Nurse (RN) with active, current, unrestricted and recognized in the relevant jurisdiction, state license in good standing in the state(s) where job duties are performed required. EXPERIENCE Minimum four (4) years' clinical practice nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing. Experience in utilization management and/or medical review preferred. ESSENTIAL SKILS & ABILITIES Oral & Written Communication Attention to Detail Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding. Ability to prioritize and make sound nursing judgments through critical thinking. Ability to build collaborative relationships. Ability to interpret complex documentation. Ability to work independently. Skills • Active Listening• Analytical Decision Making• Critical Thinking• Data Analysis• Educational Development• Interpersonal Relationship Management• Microsoft Outlook• Microsoft SharePoint• Microsoft Word• Oral Communications• Problem Sensitivity• Sound Judgment• Team Development•