Licensed UM Nurse - Remote

Job Summary

A company is looking for a Clinical Guide: UM Nurse (Outpatient Prior Authorization) to support weekend operations remotely.

Key Responsibilities

• Engage with members to assess their needs and perform clinical reviews of cases for medical appropriateness
• Coordinate care and discharge planning, ensuring members have necessary resources for post-hospital care
• Develop care plans in partnership with members and their caregivers, continuously evaluating progress

Required Qualifications

• An unrestricted RN license
• A minimum of 4 years of RN experience
• A minimum of 3 years' experience in utilization management at a health plan
• Ability to work in a fast-paced, startup environment
• Understanding of CMS guidelines and MA requirements