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Utilization Management Nurse
Cottingham & Butler. Work telephonically with providers to evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, and care .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates clinical expertise as an RN with experience in evaluating and pre-certifying medical requests, ensuring appropriate care delivery based on evidence-based guidelines. Proficient in multitasking and managing provider communications in a fast-paced environment while facilitating referrals to case management services.
Highest-signal resume keywords
RN LicenseClinical ExperienceMultitasking SkillsEmergency Room ExperienceBilingual Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
Strong Communication SkillsFast-Paced Environment Adaptability
Industry Keywords
Evidence-Based GuidelinesPre-CertificationCare ManagementCondition ManagementHealth Plan Guidelines
About the role
Key responsibilities & impact- Work telephonically with providers to evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, and care
- Review requests against evidence-based guidelines
- Ensure appropriate care and medically necessary services are provided at the right time
- Handle multiple provider phone calls in a fast-paced environment
- Work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines
Requirements
What you’ll need- RN and clinical experience
- Strong multitasking skills
- Preferably experience in ER, ICU, mental health, orthopedics, and/or pain management
- Bilingual is preferred
Benefits
Comp & perks- Medical, Dental, Vision Insurance
- Flex Spending or HSA
- 401(k) with company match
- Profit-Sharing/Defined Contribution (1-year waiting period)
- PTO/Paid Holidays
- Company-paid ST and LT Disability
- Maternity Leave/Parental Leave
- Subsidized Parking
- Company-paid Term Life/Accidental Death Insurance
- Daytime office hours
- Weekends/holidays off