Minnesota Licensed Utilization Management RN

Job Summary

To support quality patient outcomes, the part-time salaried Minnesota Licensed Utilization Management RN will assess medical necessity, manage payer denials and appeals, and collaborate with interdisciplinary teams in a fully remote environment.

Key responsibilities

• Perform and document timely utilization management reviews to ensure compliance with policies and regulations
• Facilitate secondary physician reviews to ensure accurate level of care assignment and reimbursement
• Manage concurrent payer denials through appeals related to medical necessity and track all related work

Required qualifications

• Bachelor's Degree in Nursing
• 3 years or more of Utilization Review or Case Management experience in a healthcare setting
• 1 year or more of acute care hospital nursing experience
• MN Registered Nurse (RN) License