Georgia Licensed Utilization Review Nurse
Job Summary
To support complex case evaluations, the full-time contract Georgia Licensed Utilization Review Nurse will review high-complexity clinical cases remotely, applying advanced nursing judgment and collaborating with healthcare providers and Medical Directors.
Key responsibilities
- Apply advanced nursing judgment and clinical guidelines to evaluate clinical data and determine medical necessity
- Interface with healthcare providers to assess members' symptoms and ensure appropriate care levels
- Consult with Medical Directors on complex cases and collaborate on discharge planning with case management nurses
Required qualifications
- Associate's Degree in Nursing (ADN) required
- Active and unrestricted Registered Nurse (RN) license in applicable state(s) or U.S. territories
- 4+ years of care management or case management experience combined with 2+ years of clinical, utilization review, or managed care experience
Complete Job Description
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