Healthcare Utilization Management RN

Job Summary

A healthcare company is seeking a Healthcare Utilization Management RN Lead I - BPM.

Key Responsibilities:

• Perform reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity and appropriate level of care
• Contact medical personnel to recommend alternative treatment options
• Coordinate care plans and discharge planning needs

Qualifications:

• Current unrestricted Registered Nurse license
• 2-4 years of clinical experience
• Knowledge of medical procedures/practices and healthcare delivery processes
• Medicare Advantage experience preferred
• Knowledge of applicable regulations and accreditation standards