Kansas Licensed Utilization Review Nurse

Job Summary

To support healthcare programs that improve outcomes, the remote Prior Authorization Utilization Review Nurse will review prior authorization requests, evaluate medical necessity, and collaborate with providers and internal stakeholders.

Key responsibilities

• Review and evaluate prior authorization requests for medical necessity and cost-effectiveness
• Serve as a clinical resource for providers and internal teams, resolving healthcare-related questions
• Collaborate with stakeholders to facilitate timely and appropriate healthcare decisions

Required qualifications

• Bachelor's degree or equivalent combination of education and experience
• Active, unrestricted RN or LPN license in the United States
• Two or more years of Medicaid or relevant healthcare experience
• Previous experience in Utilization Review, Prior Authorization, or Managed Care programs
• Ability to interpret complex regulatory and procedural documents