Multistate Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Management Registered Nurse to manage authorization requests and clinical inquiries.

Key Responsibilities

• Review requests for medical services and ensure timely determinations based on established criteria
• Act as an advocate for members in accessing necessary healthcare services and respond to inquiries regarding requests
• Support onboarding for new UM staff and participate in process improvement initiatives

Required Qualifications

• Current unrestricted Registered Nurse (RN) license with multistate capability
• Preferred one year of experience in Utilization Management (UM) or Utilization Review (UR) and managed care
• Knowledge of medical/surgical terminology and Medicare managed care authorization processes
• Ability to work independently and make decisions with minimal supervision
• Demonstrated professionalism and ability to maintain confidentiality