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 collaborate with healthcare providers
• Manage medical claims disputes and ensure compliance with regulatory guidelines
• Coordinate transitions of care and establish discharge plans for patients

Required Qualifications

• Associate's degree in nursing; Bachelor's degree preferred
• Compact RN license required
• 3+ years of clinical nursing experience, preferably in a hospital setting
• 2+ years of Utilization Management experience in a health plan UM department
• Certification in managed care nursing or care management preferred