Maine Licensed Utilization Management RN

Job Summary

A company is looking for a Per Diem Utilization Management RN for a national remote position.

Key Responsibilities:

• Validates authorization for procedure and bedded patients and ensures timely acquisition of pre-certification and continued stay authorizations
• Conducts medical necessity reviews and collaborates with care teams to validate information and support denials management
• Coordinates utilization reviews for all payers upon admission and throughout inpatient stays, ensuring compliance with Utilization Management Plan

Required Qualifications:

• Associate's degree (or higher) in Nursing
• Current and 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 knowledge of insurance and denials management