Licensed Utilization Management Nurse

Job Summary

Working remotely within Oregon, Washington, Idaho, or Utah, the full-time Licensed Utilization Management Nurse will conduct utilization management reviews to ensure medical necessity and compliance, collaborating with interdisciplinary teams to facilitate care transitions and improve quality outcomes.

Key responsibilities

• Conducts prospective, concurrent, and retrospective utilization management reviews to assess medical necessity and adherence to policies
• Applies clinical expertise and evidence-based criteria for decision-making, consulting with physician advisors as necessary
• Collaborates with interdisciplinary teams and case management to address care transitions and resolve issues effectively

Required qualifications

• Associate or Bachelor's Degree in Nursing or a related field
• At least 3 years of experience in case management, utilization management, or related fields
• Current licensure or certification in a health or human services discipline allowing independent assessments
• May require licensure in Idaho, Oregon, Utah, and Washington
• Must possess a current unrestricted RN license for medical care management or a relevant higher degree in health or human services