RN Clinical Review Prior Authorization UM Specialist

Accurate application of HealthPartners evidence-based coverage criteria in alignment with member benefit plan, responsible for making accurate coverage determinations, serve as subject matter expert on complex utilization management issues, and maintain understanding of state and federal regulations, accreditation standards, HealthPartners products and networks.

Requirements

• Currently licensed Registered Nurse
• Minimum of three years clinical practice experience as an RN in medical/surgical, critical care, home care, or equivalent knowledge of current hospital and clinical care processes
• Clear and concise verbal and written communication and interpersonal skills
• Ability to use critical thinking skills for problem solving
• Ability to organize and prioritize multiple assignments within workload
• Ability to function independently and take independent action, within the scope of job responsibilities
• Competency in personal computer skills including Microsoft word, Outlook and Internet
• Ability to deal with change and ambiguity

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan
• Visa Sponsorship
• Four Day Work Week
• Generous Parental Leave
• Tuition Reimbursement
• Relocation Assistance