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Maine Licensed Utilization Management RN
Job Summary
A company is looking for a Per Diem Utilization Management RN - National Remote.
Key Responsibilities
- Validates and obtains authorization for procedures and patient admissions, ensuring compliance with payer requirements
- Conducts medical necessity reviews and collaborates with care teams to manage concurrent cases and denials
- Documents clinical reviews and supports the medical chart audit process to ensure accurate utilization management
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, and working with insurance and denials
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COMPLETE JOB DESCRIPTION
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