Registered Nurse / RN - Utilization Management I
Registered Nurse / RN - Utilization Management IThe Registered Nurse - Utilization Management I is responsible for supporting specific utilization management (UM) program functions within the Clinical Operations department. UM program functions include Benefit Management, Benefit Review, Appeals and Grievances and Health Related Services (HRS). Together they support the healthcare needs of members, determine the best medically appropriate services, and apply clinical-based criteria for decision-making while managing medical expenses. NOTE: This position focuses on Appeals and Grievance. Estimated Hiring Range: $102,330.00 - $125,070.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. Essential Responsibilities General Duties Communicate with members and/or providers in a professional manner and in accordance with State and Federal requirements as needed to complete requests. Maintain co