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CategoryHealthcare
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No of Jobs1
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Apply Before12/08/2025
Description
Utilization Management Nurse - Medicare
Blue Cross and Blue Shield of Nebraska - Omaha, NE
Job Title: Utilization Management Nurse - Medicare
Position: Remote Nurse Analyst
Job Type: Full Time
Pay:
Shift: Rotating weekend/holiday shifts as needed
Work Type: Remote
Location
Address:
City: Omaha
State: NE
ZIP Code:
Job Responsibilities
- Conduct prospective, concurrent, retrospective, and post-service clinical claim certification and authorization reviews.
- Assess the medical necessity of medical and/or behavioral health inpatient admissions, outpatient services, and appropriateness of treatment setting.
- Educate providers about member benefits, coverage, and provider networks.
- Facilitate appropriate and timely transitions of care.
- Identify members appropriate for care management programs and make referrals to care management nurses.
- Collaborate and consult with healthcare providers, internal team, and specialists.
- Act as a resource within the department and to other departments regarding medical management issues.
- Maintain compliance with Medicare Advantage, URAC accreditation standards and other regulatory requirements.
- Responsible for maintaining professional licensure and practicing within the scope of licensure.
- Complete special projects like training new hires, provider outreach, and system training.
Required Skills
Core Skills
- Current, unrestricted Registered Nurse license
- Clinical practice experience in a healthcare setting
- Experience with Medicare Advantage and Managed Care organizations
- Knowledge of discharge planning, utilization management, and case management
Preferred Skills
- Bachelor’s degree in healthcare field
- Clinical experience in multiple levels of care
- Knowledge of accreditation standards and regulatory requirements
Requirements
Experience: Three (3) years’ clinical practice experience in a health care setting
Education: Associate's degree in nursing
License & Certification:
- Current, unrestricted Registered Nurse license from Nebraska or consortium state
Schedule:
- Rotating weekend/holiday shifts as needed
COVID-19 Requirements: Not Specified
Benefits
- Not specified
Supplemental Pay
- Not specified
Special Notes
- Diversity of experience, perspective, and background is valued.
Facility Details
Name: Blue Cross and Blue Shield of Nebraska
Description: A mission-driven organization dedicated to championing the health and well-being of members and communities.
Specialties:
- Health Insurance
- Medicare Advantage
Mission: To deliver on the promise of high-quality, medically necessary care.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
12/08/2025
Posted:
09/08/2025
