Nebraska Licensed Utilization Management RN

Job Summary

To support the clinical and financial coordination of patient care, the full-time Nebraska Licensed Utilization Management RN will conduct utilization reviews, collaborate with healthcare teams, and manage denials and appeals processes in a 100% remote setting.

Key responsibilities

• Perform utilization review activities, including concurrent and retrospective reviews, to determine medical necessity
• Collaborate with healthcare providers to manage patient length of stay and ensure compliance with insurance authorizations
• Participate in the denials and appeals process by researching issues and providing necessary documentation for appeals

Required qualifications

• Current Registered Nurse licensure from the State of Nebraska or an approved compact state
• Two years of clinical experience and preferred experience in utilization management and the denials process
• Basic Life Support (BLS) certification required
• Knowledge of governmental and third-party payer regulations related to patient hospitalization
• Ability to analyze clinical denial data to identify trends and recommend process improvements