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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 expertise in evaluating and pre-certifying medical requests while ensuring compliance with evidence-based guidelines. Proficient in managing multiple provider interactions in a fast-paced environment, with a focus on delivering appropriate care and referrals.
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.
Hard Skills
Clinical EvaluationPre-CertificationEvidence-Based Guidelines ReviewCare CoordinationReferral Management
Soft Skills
Strong CommunicationTime ManagementProblem-Solving
Certifications & Qualifications
Registered Nurse (RN)
Industry Keywords
Outpatient SurgeryHospital StayCondition ManagementCase ManagementMental HealthOrthopedicsPain Management
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 proper care, medically necessary services, and the right service 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
- Clinical experience preferably in ER, ICU, mental health, orthopedics, and/or pain management
- Bilingual 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
- Most benefits start day 1