Licensed NICU Utilization Nurse

Job Summary

To support the delivery of quality care, the full-time Licensed NICU Utilization Nurse will coordinate member care from pre-admission through discharge, ensuring compliance with managed care policies while working remotely.

Key responsibilities:

• Initiating the continuum of care process for neonatal admissions
• Interacting with hospital staff to collect clinical information for medical necessity determinations
• Coordinating discharge planning needs for newborns from intensive care nurseries

Required qualifications:

• Registered Nurse (RN) with a current, unrestricted license
• Three or more years of clinical experience as a nurse in a Level III or Level IV NICU
• Three or more years of experience in concurrent review or discharge planning within a health plan or acute facility
• Experience with Interqual and/or MCG preferred
• Strong computer skills and experience with data entry into a database or EHR