Georgia Licensed Med Management Nurse

Job Summary

To support effective healthcare delivery, the contract Georgia Licensed Med Management Nurse will review complex medical necessity cases, collaborate with healthcare providers, and contribute to quality improvement initiatives while working remotely with occasional onsite attendance.

Key responsibilities

• Review and evaluate complex medical necessity requests using clinical guidelines and nursing judgment
• Collaborate with healthcare providers to gather and interpret clinical information for utilization management decisions
• Support discharge planning activities and promote quality member outcomes through effective care management

Required qualifications

• Associate Degree in Nursing (ADN) required
• Active, unrestricted Registered Nurse (RN) license in applicable state(s) or U.S. territory
• Multi-state licensure required if providing services across multiple states
• Minimum 4 years of care management or case management experience
• Minimum 2 years of clinical, utilization review, or managed care experience