RN Utilization Management - Off Shift
Arkansas Blue Cross & Blue Shield | |
United States | |
Dec 28, 2024 | |
To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.
Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:
Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.
Workforce Scheduling EDUCATION LICENSING/CERTIFICATION EXPERIENCE Note: Employees meeting these qualifications and accepting this role with this schedule will be provided a $ 5,000 premium added to their base salary. ESSENTIAL SKILLS & ABILITIES services, and surgery; documenting all relevant and specific information; and screens, prioritizes and organizes determination requests according to mandates and standards., Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations; making decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety., Promotes appropriate care and quality toward cost effective and cost containment measures based on evidence., Provides primary utilization management review and communication for both scheduled workdays during the regular workweek AND scheduled weekend period., Remains current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery; and enterprise procedures, policies and contracts., Works incoming and outbound calls and/or queues from multiple sources within mandated requirements proactively and effectively. Certifications Security Requirements This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of DutiesSegregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual. Employment TypeRegularADA Requirements 2.1 General Office Worker, Semi-Active, Campus Travel - Someone who normally works in an office setting or remotely, periodically has lifting and carrying requirements up to 40 lbs and routinely travels for work within walking distance of location of primary work assignment as essential functions of the job. |