Maine Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse - Remote.

Key Responsibilities

• Review prior authorization requests for medical necessity and manage medical claims disputes
• Coordinate transitions of care and referrals to Care Management while collaborating with healthcare providers
• Complete documentation of reviews and decisions according to compliance requirements

Required Qualifications

• 3+ years of clinical nursing experience as an RN, preferably in a hospital setting
• Utilization management experience in a health plan UM department
• Compact RN License
• Certification in managed care nursing or care management desired (CMCN or CCM)