California Licensed Utilization Nurse

Job Summary

A company is looking for a Utilization Management Nurse - Remote.

Key Responsibilities

• Conducts clinical reviews for appropriate utilization of medical services using medical necessity criteria
• Documents clinical reviews and decisions in the care management system accurately and timely
• Collaborates with the Medical Management team for care coordination and prepares clinical information for case reviews

Required Qualifications

• Current unrestricted Registered Nurse (RN) license in state of residence
• 3+ years of clinical nursing experience in an acute care hospital or LTAC setting
• 1+ years of Utilization Management experience in a hospital or insurance setting
• Experience applying Medicare and/or Medicaid guidelines
• Experience with Milliman (MCG) or InterQual guidelines