Utilization Management Nurse

Job Overview

We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, but that and prefers working in a professional office setting with daytime office hours and weekends/holidays off.

This position is responsible for working telephonically with providers to evaluate and pre certify requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc. Review requests and match up to an evidence based guideline to ensure proper care and ensure the right service is happening at the right time and is medically necessary. In this position you will be handling multiple provider phone calls at any given time and need to be able to handle a very fast paced environment. You will also work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines.

Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably in ER, ICU, mental health, orthopedics, and/or pain management. Bilingual is also preferred.

About the company

At Cottingham & Butler, we sell a promise to help our clients through life’s toughest moments. To ensure we keep that promise, we hold ourselves to a set of principles that we believe position our clients and our company for long-term success. Our Guiding Principles are not just words on paper, they are a promise we make to ourselves and our clients.

These principles have become a driving force of our culture and share many common themes with the values of our clients. First, we hire and develop amazing people that have an insatiable desire to succeed, are committed to learning, and thrive on challenge. Secondly, we pride ourselves on serving our clients best interest through quality service, innovative solutions, and constantly evaluating our performance. Third, we have embraced and are guided by the theme of “better every day” constantly pushing ourselves to be better than yesterday. Ultimately, we get more energy from the future we are creating for our people, our clients, and our company than from our past success.

As an organization, we are very optimistic about the future and have incredibly high expectations for our people and our performance. We also understand that our growth is fueled by becoming better, not bigger – growth funds investments in new resources to better serve our clients and provide the career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.