Nevada Licensed Utilization Management RN

Job Summary

Working full-time, the Nevada Licensed Utilization Management RN will apply utilization management processes, assess clinical information for medical necessity evaluations, and collaborate with interdisciplinary teams to ensure quality care and compliance with regulations.

Key responsibilities

• Manage medical necessity evaluations for prior authorizations and concurrent reviews using designated criteria
• Coordinate with healthcare teams to facilitate discharge planning and optimize member care while tracking clinical denials
• Participate in interdisciplinary meetings to assure appropriate resource utilization and level of care decisions

Required qualifications

• Current and unrestricted State of Nevada Registered Nurse license
• Bachelor of Science in Nursing Degree preferred
• Minimum of two years of clinical experience in inpatient or outpatient settings
• Two to three years of experience in managed care utilization management or case management recommended
• Proficiency in Microsoft Office Suite and ability to complete online learning requirements