Compact RN Utilization Management
Job Summary
To support efficient health service delivery, the remote Compact RN Utilization Management will assess member needs, determine medical appropriateness for various care levels, and identify solutions to complex utilization management issues while operating in Pacific or Mountain Time Zones.
Key responsibilities:
- Conduct prior authorization reviews for skilled nursing facilities and acute care settings
- Evaluate medical guidelines to determine the appropriateness of care levels
- Act as a resource for complex issues, providing explanations and solutions for non-standard requests
Required qualifications:
- Compact RN License
- 3+ years of managed care and/or clinical experience
- Prior utilization management experience (not case management)
- Proven basic computer skills with MS Outlook, Word, and Excel
Complete Job Description
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