Utilization Management Nurse Reviewer

United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates must possess an active and unrestricted LVN/RN license, a minimum of 2 years of clinical nursing experience, and at least 1 year of utilization management experience. Proficiency in written and spoken communication, strong organizational skills, attention to detail, and experience with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) are essential. Familiarity with medical management platforms and established utilization review criteria (e.g., CMS, Milliman Care Guidelines, InterQual) is also required.

Responsibilities

The Utilization Management Nurse Reviewer will assess the appropriateness and medical necessity of treatments and services using established criteria, review patient records for quality of care, and provide clinical expertise to non-clinical staff. Responsibilities include managing clinical details in medical management platforms, staying updated on regulatory requirements, applying clinical reasoning to guidelines, and communicating effectively with healthcare providers and management to optimize patient care and control costs. The role may also involve overseeing team members and acting as the final approver for cases.

Skills

Utilization Management

Clinical Review

Medical Records Review

Treatment Plan Assessment

Healthcare Systems

Cost Control

Quality Care

Medical Necessity Assessment

Care Coordination

Utilization Reviews

Clinical Reasoning

Evidence-Based Guidelines

Regulatory Compliance

Communication Skills

Critical Thinking

URAC

CMS

Milliman Care Guidelines

InterQual

Blank Street

Specialty coffee shop with efficient service

About Blank Street

Blank Street provides a unique coffee shop experience by offering high-quality coffee and food at affordable prices. The company started with a small coffee cart in Brooklyn and has since expanded to major cities like New York, London, Boston, and Washington, D.C. Their product offerings include specialty coffees sourced from around the world and fresh, locally-sourced food. Customers can enjoy a quick yet premium experience, thanks to the efficiency of their small locations that help keep costs down. Blank Street differentiates itself from competitors by focusing on customer convenience through technology, such as their app that allows for ordering ahead, customizing drinks, and participating in loyalty programs. They also prioritize employee satisfaction by paying baristas above-market wages. The goal of Blank Street is to redefine the coffee shop experience by combining quality, affordability, and exceptional service, making it a significant player in the specialty coffee market.

New York City, New YorkHeadquarters

2020Year Founded

$50.6MTotal Funding

EARLY_VCCompany Stage

Food & Agriculture, Consumer SoftwareIndustries

201-500Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Paid Vacation

Paid Sick Leave

Paid Holidays

Parental Leave

Flexible Work Hours

Company Equity

Risks

Rapid expansion may lead to operational inefficiencies and overextension.

Subscription program may not resonate with all customer segments, risking dissatisfaction.

Reliance on outsourced vendors poses risks if supply chain disruptions occur.

Differentiation

Automated espresso machines ensure consistent quality and enhance barista-customer interaction.

Small, cost-effective locations reduce overhead and allow competitive pricing.

Focus on high-quality, clean, and natural products at affordable prices.

Upsides

Rapid expansion into major cities increases brand visibility and market presence.

Subscription model provides steady revenue and enhances customer loyalty.

Partnerships with lifestyle brands boost brand visibility and customer engagement.

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