Top 23 Utilization management nurse Jobs in Omaha, Ne

Utilization Management Nurse
Detego Health —Omaha, NE
- $75,000 - $85,000 a year
- Full-time
- RN License
- Mid-level
- Office
Quick Apply
1d
Nurse Disability Consultant
Lincoln Financial —Omaha, NE
- $72,900 - $131,600 a year
- Online Application
- Remote
- Nursing
- RN License
- Mid-level
- Disability insurance
- Tuition reimbursement
Utilization Review Nurse
Berkshire Hathaway Homestate Companies —Omaha, NE
- Full-time
- Hybrid work
- Nursing
- RN License
- 5 years
- Free parking
- AD&D insurance
Quick Apply
Medical Field Case Manager
Enlyte —Omaha, NE
- $70,600 - $89,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Travel reimbursement
- Health savings account
Manager Utilization Management
P3 Health Partners —Omaha, NE
- $100,000 - $140,000 a year
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
7d
Clinical Intake Specialist
Hillcrest Health Services —Bellevue, NE
- Full-time
- Remote
- Nursing
- RN License
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
6h
Clinical Documentation Specialist
Nebraska Methodist Health System —Council Bluffs, IA
- Full-time
- Nursing
- RN License
- Hospital
Registered Home Healthcare and Hospice Nurse
Prime Home Care, LLC —La Vista, NE
- $35 - $44 an hour
- Full-time
- Nursing
- RN License
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
RN Care Manager - Omaha Market
ArchWell Health —Omaha, NE
- Full-time
- Nursing
- RN License
- Mid-level
14d
Certified Wound Care Clinician/Nurse
Gentell —Omaha, NE
- Full-time
- Nursing
- RN License
- Sales
- Opportunities for advancement
Quick Apply
Charge RN
CHI Health Creighton University Medical Center - Bergan Mercy —Omaha, NE
- $36.94 - $53.56 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
Nurse Coordinator - Ortho Neuro - Full Time - Nights
Nebraska Methodist Health System —Omaha, NE
- Full-time
- Acute care
- Nursing
- Surgery
Registered Nurse - Medical/Surgical
US Veterans Health Administration —Omaha, NE
- $65,500 - $140,292 a year
- Online Application
- Acute care
- Background check
- Nursing
- Paid holidays
- Loan repayment program
Nurse Coordinator - PCU - Cardiac/Vascular/Thoracic - Nights
Nebraska Methodist Health System —Omaha, NE
- Full-time
- Acute care
- Nursing
- Surgery
Charge RN
CHI Health Mercy Council Bluffs —Council Bluffs, IA
- $36.94 - $53.56 an hour
- Full-time
- Nursing
- Surgery
- RN License
Registered Nurse - Acute Care for Elders - Nights
Nebraska Methodist Health System —Omaha, NE
- Full-time
- Acute care
- Nursing
- RN License
- Free parking
- Paid training
Home Health Clinical Manager
Centerwell —Omaha, NE
- $69,500 - $95,600 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays

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Nurse Disability Consultant
Lincoln Financial —Omaha, NE
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Learning Center Consultant - RN - PRN/Casual
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Current valid Nebraska Registered Nurse (RN) License, valid compact multistate license to work in Nebraska, or a temporary permit while awaiting licensure…

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This position maintains awareness of emerging state and national healthcare trends and drives initiatives to enhance care quality and ensure effective resource…
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Utilization Management Nurse

Detego Health -
Omaha, NE

Quick Apply

Job Details

Full-time
$75,000 - $85,000 a year
1 day ago

Qualifications

Teamwork
RN License
Patient assessment
Health insurance policy knowledge
Regulatory compliance
Utilization management
Attention to detail
Resource utilization in healthcare

Full Job Description

Position Summary

As a Utilization Management Nurse you will work with members to ensure they obtain the proper healthcare in the most cost-effective manner. The Utilization Management Nurse will also review planned, in-process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria.

Key Responsibilities (included but not limited to): · Conduct thorough reviews of medical records, treatment plans, and other relevant documentation to determine the medical necessity and appropriateness of healthcare services.· Communicate with healthcare providers, insurance companies, and other stakeholders to gather necessary information and discuss patient care plans.· Maintain detailed records of utilization management activities, including findings, decisions, and communications with stakeholders.· Ensure that all utilization management activities adhere to regulatory requirements, accreditation standards, and organizational policies and procedures.· Identify opportunities to optimize healthcare resources, such as by recommending alternative treatments or care settings that may be more cost-effective or clinically appropriate.· Advocate for patients' rights and ensure that they receive timely and appropriate healthcare services based on their individual needs.· Participate in quality improvement initiatives aimed at enhancing the efficiency, effectiveness, and safety of healthcare delivery.· Coordinate peer-to-peer reviews between providers and medical directors in determining coverage of requested services.· Refer members with costly medications or non-covered medications to ScriptAide for assistance via the Patient Assistance Program or the Prescription Importation Program.· Collaborate with the Medical Director on review of procedures/medications that do not meet medical necessity review per clinical guidelines. · Provide procedure and/or medication cost to the member’s plan.

Career experience required:

· Active RN license preferred; or, LPN license

· Health plan utilization management experience

· Strong clinical assessment skills

· Excellent communication and interpersonal skills

· Ability to work independently and collaboratively in a fast-paced environment

· Knowledge of healthcare regulations and reimbursement policies

· Experience with a TPA or in the health insurance industry preferred

Behavioral competencies desired:

· Critical Thinking – Use of exceptional critical thinking skills and attention to detail

· Analytical Skills – Analyze information and exercise sound judgement when making decisions

· Innovation – Take a multi-faceted approach to problem-solving and creation of novel solutions to problems. Champion organization-wide learning and sharing of information. Take a viewpoint that is broader than one’s immediate group or department and encompasses external factors.

· Collaboration – Understand the importance of relationships to enable effective teamwork. Modify personal style, focus on the needs of others, and listen effectively to ensure effective outcomes for group endeavors.

· Business Acumen – Knowledge of general business practices in the TPA world as well as knowledge of the organization’s functioning. An understanding of organizational culture and the ability to function effectively within its social structure.

Pay: $75,000.00 - $85,000.00 per year

Work Location: In person

Quick Apply

Refine Your Search

utilization management nurse jobs in omaha, ne

Utilization Management Nurse

Nurse Disability Consultant

Utilization Review Nurse

Medical Field Case Manager

Manager Utilization Management

Clinical Intake Specialist

Clinical Documentation Specialist

Registered Home Healthcare and Hospice Nurse

RN Care Manager - Omaha Market

Certified Wound Care Clinician/Nurse

Charge RN

Nurse Coordinator - Ortho Neuro - Full Time - Nights

Registered Nurse - Medical/Surgical

Nurse Coordinator - PCU - Cardiac/Vascular/Thoracic - Nights

Charge RN

Registered Nurse - Acute Care for Elders - Nights

Home Health Clinical Manager

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