Job Summary

• The Utilization Review Nurse performs prospective review (benefit advisory/ prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers.
• The incumbent partners with Medical Directors and other Premera Departments such as FEP, National Account Liaisons, Health Care Services, and Claims to ensure appropriate cost-effective care by applying their clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, benefit application and provider out of network requests.
• Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow.

Matching Summary

Salary

National Salary Range: $80,200.00 - $125,600.00; National Plus Salary Range: $84,200.00 - $143,100.00; Benefits: Medical, vision, and dental coverage with low employee premiums, voluntary benefit offerings, life and disability insurance, retirement programs, wellness incentives, generous paid time off, tuition assistance, employee recognition program

Skills & Requirements

Key Requirements

• Bachelor's degree or 4 years' work experience
• Current State licensure as a registered nurse
• 3 years of clinical experience
• CPHM certification or obtain within 36 months
• Utilization Management experience

Work Rights