Career Opportunities

Utilization Management Nurse

Utilization Management Nurse

We are a West Michigan health plan benefits administrator seeking to hire an individual that has a desire to grow with us. We are looking for a Utilization Management Nurse to join our Health Management Department. A Utilization Management Nurse is responsible for assuring the member is receiving high quality, cost efficient medical outcomes for those members identified as having the need for inpatient and or outpatient precertification/preauthorization. This position requires high level of confidentiality, professionalism, and ability to problem-solve and remain pro-active when dealing with existing member and member issues.

Essential Duties and Responsibilities:

  • Must have broad nursing background and high degree of professionalism with sound nursing judgement
  • Must have excellent critical thinking skills, strong attention to detail and the ability to problem solve effectively
  • Must have the ability to exercise independent nursing judgment and to work within established procedures and guidelines as well as to work in a team environment
  • Must be able to prioritize effectively in a fast paced work environment
  • Must have ability to meet deadlines with a variety of responsibilities
  • Must demonstrate excellent verbal, written and customer service skills
  • Must exhibit the ability to be trustworthy, punctual and consistent in attendance
  • Must have ability to learn and effectively work in computer applications
  • Must be knowledgeable and proficient in performing prospective, concurrent and retrospective medical necessity reviews on a variety of services/care levels
  • Must be knowledgeable and able to assess appropriate levels of care and transitions across the continuum of care
  • Responsible to ensure compliance with regulatory requirements and procedures
  • Ability to communicate effectively across the interdisciplinary health care team
  • Identifies potential high dollar/catastrophic cases
  • Identifies members appropriate for Case Management services
  • Identifies opportunities for cost savings while maintaining or improving quality of care across the continuum of care
  • Collaborates with Claims Unit staff regarding health plan eligibility of services

Education and Experience:

A current unrestricted Michigan RN license is required with either an associate’s or bachelor’s degree or diploma from an accredited nursing program.   A Bachelor of Science degree is preferred.  A broad nursing background including a minimum of 6 years of nursing experience is required. Utilization review experience and/or Care coordination/discharge planning experience preferred. Experience in a Third Party Administrator or managed care environment is desirable. The position offers an attractive salary, and an excellent benefit package, including a substantial employer matching contribution to our 401K.

You can apply online at under CAREERS at the home page. Please send your resume with a cover letter to Utilization Management Nurse, Human Resources, ASR health benefits, 618 Kenmoor Ave SE, Suite 200, Grand Rapids MI 49546 or fax to 616.464.4463. No agencies please. EOE