Utilization Review Nurse

#26-6187 Apply X Facebook LinkedIn Email Copy Employment Type Full-time Exempt or Non-Exempt Exempt Job Summary **Hybrid Work Environment - Must reside in Hawaii** Pay Range: $59k to $116k Note: Individuals typically begin between the minimum to middle of the pay range Participate in and/or lead activities to support Utilization Management (UM) reporting requirements and all UM systems(s) and/or application users in the use, development, and implementation for the management of operational activities and system solutions Minimum Qualifications Bachelor's degree and two years of related work experience; or equivalent combination of education and related work experience. Good verbal communication skills to present information before groups, departments, and management. Good written skills to compose business correspondence, policies & procedures, work plans, with high degree of accuracy. Good organization and time management skills. Good business knowledge and experience. Strong analytical, organizational, and time-management skills. Strong analytical skills. Intermediate working knowledge of Microsoft applications, including but not limited to Word, Excel, Outlook, and PowerPoint. Duties and Responsibilities Support Medical Management (MM)'s business solution requirements for the department through data reporting from various HMSA system applications and analytics utilizing established techniques or tools. Solicit, document and/or clarify with business the reporting requirements and scope to include but not limited to what question is the business trying to answer, intent of the detailed data, anticipated audience, and summary requirements. Maintain requisite knowledge of the current regulatory reporting requirements, including participation in relevant internal calls and/or meetings, researching and reading reporting guideline documentation. Maintain requisite knowledge of current workflows for primary reporting requirements, including participation in meetings with the business and/or user groups. Maintain requisite knowledge of reporting software / application used to support ALL reporting requirements through available documentation and/or attend trainings. Participate in system implementation projects under the direction of the Senior Business Solutions Analyst, Business Solutions Administrator and/or Information Management Manager. Solicit and document system and/or business requirements for a system solution to include but not limited to participation in calls, workgroups and/or meetings. Develop and/or assist in the creation of various tools to support Utilization Management activities which may include system configuration, test case development and/or testing. Provide feedback and/or elevate complex issues / concerns to appropriate lead. Lead and/or coordinate specific activities that support department requirements under the direction of Information Management Manager, Director or Vice President of the department. Manage the schedule, development, testing and implementation, as necessary, of the specific activity for the targeted audience(s). Maintain requisite knowledge of the specific activity; including participation in relevant internal calls and/or meetings, researching and reading updated material/documentation. Provide system support to all users on the various utilization management systems managed by Medical Management Department. Resolve inquiries submitted directly to MM initiated through email, calls and walk-ins. Assist Solutions Analyst with resolving more complex inquiries Elevate unresolved complex inquiries. Analyzes business problems and issues; coordinates input from various departments, units and/or staff to provide a recommendation or resolution to appropriate business owners. Organize and conduct training on how to utilize solutions, includes systems and/or applications administered or developed by the MM. Coordinate and manage the security and equipment requirements for the department. Completion, submission and tracking of access management requests. Completion, submission and tracking of purchase requisitions for computer equipment. Performs all other miscellaneous responsibilities and duties as assigned or directed. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact808-948-5588 or via email at View email address on click.appcast.io. EEO is the Law ADP Privacy Statement Artificial Intelligence Google Privacy Policy Google Terms of Service #J-18808-Ljbffr