Maine Licensed Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse RN - Per Diem - Remote Nationwide.

Key Responsibilities

• Validates authorization for procedures and ensures timely acquisition of pre-certification and continued stay authorizations from payers
• Conducts utilization and medical necessity reviews, collaborating with care teams to ensure compliance with criteria
• Manages concurrent cases and supports denials management by documenting activities and working to overturn denials

Required Qualifications

• Associate's Degree (or higher) in Nursing
• Current, unrestricted RN Compact State licensure or unrestricted RN license in state of residence and Maine
• 3+ years of acute clinical practice or related health care experience
• 1+ years of Utilization Management RN experience
• Experience with Cerner and InterQual, as well as working with insurance and denials