Nebraska Licensed Utilization Nurse
Job Summary
Working remotely in a full-time capacity, the Nebraska Licensed Utilization Nurse will conduct clinical claim certification reviews, educate providers on member benefits, and facilitate transitions of care to ensure members receive high-quality, medically necessary care.
Key responsibilities
- Conduct clinical claim certification and authorization reviews to assess medical necessity and appropriateness of treatment settings
- Educate healthcare providers about member benefits and utilization management processes
- Collaborate with healthcare providers and internal teams to promote positive member outcomes and optimize resource use
Required qualifications
- Associate's degree in nursing
- Three years of clinical practice experience in a healthcare setting
- Active, unrestricted Registered Nurse license from Nebraska or a participating consortium state
- Experience in Managed Care organizations, including Medicare or Commercial Insurance
- Experience in discharge planning, utilization management, or case management
Complete Job Description
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