Schedule:
This is an Alternative WorkScheduleweekend position. The role requires coverage of both Saturday and Sunday each week.Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs.Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage.

Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options tofacilitateappropriate healthcareservices and benefits for members.

Key Responsibilities:

* Gather clinical information and apply theappropriate clinicalcriteria, guidelines, policies, procedures, and clinical judgment torendercoverage determinations and recommendations along the continuum of care.
* Communicate with providers and other parties tofacilitatecare and treatment.Identifymembers for referral opportunities to integrate with other products, services, or benefit programs.
*Identifyopportunities to promote quality and effectiveness of healthcare services and benefitutilization
* Consult and lendexpertiseto other internal and external constituents in the coordination and administration of the utilization/benefit management function.
* Meet set productivity and quality expectations asestablishedby UMNC.

Required Skills and Abilities:

* Effective verbal and written communication skills.
*Proficiencywith computer skills, including navigating multiple systems and keyboarding.
* Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
* Capacity to sit for extended periods, talk on the telephone, and type on the computer.

Work Location:

This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at theoffice or client location may berequiredfor meetings, training sessions, or other events as directed.

`Required Qualifications

• Registered Nurse

• Education:Diploma RNacceptable;Associate degreeBSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting,and 1+ years of Utilization Management / CareManagementExperience

• Must have active current and unrestricted RN licensure in state of residence.

• May berequiredto obtainadditionalNursing Licenses as business needsrequire.