Utilization Specialist II

Minimum Qualifications: Bachelor’s degree in Nursing. Massachusetts RN Licensure. Obtain appropriate state board where services will be provided as a registered professional nurse OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) within three (3) months of hire. Three (3) years hospital/health care experience in the area of Utilization Management. Basic Life Support Certification OR Obtain within three (3) months. Preferred Qualifications: Five (5) years hospital/health care experience in the areas of Utilization Management with acute, subacute, home care, palliative care and hospice experience. Case Management experience. Case Management Certification. Physical Requirements: Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc. This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending / descending stairs and operate office equipment. Frequently required to speak, hear, communicate and exchange information. Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols. Occasionally lift and/or move up to 25 pounds. Skills & Abilities: Knowledge of hospital and medical terminology and insurances. Familiarity with the target community and feels connected to that community. Excellent relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness. Demonstrated ability to problem solve complex, multifaceted, emotionally charged situations. Excellent communication skills (telephonically and face-to-face). Ability to work well with people of various ages, backgrounds, ethnicities, and life experiences. A robust understanding of chronic health condition management and population management. Motivational Interviewing proficiency. Ability to prioritize and resolve critical issues efficiently and effectively. Detail oriented, with strong organizational skills and multi-tasking abilities. Very strong working knowledge and proficiency with technology and business software (Word, Excel, Outlook), e-mail and automated scheduling software and the ability to navigate through hospital-based computer systems. Experience with Electronic Medical Records and possess a willingness and ability to learn and utilize new technology and procedures that will continue to develop in their role and throughout the organization. Ability to work independently with minimal supervision and as part of a team. Strong understanding of and ability to interact with various care settings, including post-acute settings, community-based options, and home care resources. Proficient with InterQual criteria and guidelines.

Need help crafting an effective cover letter and resume for this role?

Get access to our expert resources: our proven framework offers successful strategies, helps you find the best-fit positions, craft standout cover letters, optimize your resume, and much more.

Get Started