Compact RN Utilization Review Nurse

Job Summary

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

Key Responsibilities

• Review prior authorization requests for medical necessity and manage claims disputes
• Coordinate transitions of care and collaborate with healthcare providers to promote effective resource utilization
• Document reviews and decisions, maintain compliance with regulatory guidelines, and participate in quality initiatives

Required Qualifications

• 3+ years of clinical nursing experience as an RN, preferably in a hospital setting
• Utilization management experience in a health plan UM department
• Compact RN License
• Certification in managed care nursing or care management desired (CMCN or CCM)