Nevada Licensed Utilization Manager

Job Summary

To ensure timely access to care, the full-time remote Nevada Licensed Utilization Manager will manage prior authorizations and concurrent review authorizations, leveraging clinical knowledge and relationship-building skills to facilitate patient transitions and streamline the authorization process.

Key responsibilities

• Oversees the authorization process by reviewing medical records and coordinating with referring hospitals and case management teams
• Generates written appeals for denied authorizations, utilizing clinical and regulatory knowledge to advocate for patients
• Maintains effective communication with stakeholders, ensuring timely processing of authorizations and compliance with regulatory standards

Required qualifications

• Postsecondary certificate, diploma, or program graduation from an accredited school of nursing or an Associate's Degree in healthcare
• Preferred Bachelor's Degree in healthcare or a related field
• Three or more years of experience in a healthcare setting, preferably in managed care or utilization review
• Healthcare licensure may be preferred unless required by the state of practice
• Strong knowledge of medical necessity justification and regulatory compliance guidelines