New York Licensed Pediatric RN

Job Summary

A company is looking for a Utilization Management RN Pediatrics (Remote).

Key Responsibilities

• Perform concurrent review of pediatric clinical cases for medical necessity and appropriateness of care
• Conduct review of prior authorization and precertification requests for pediatric services and treatments
• Collaborate with providers and care teams to support coordinated care planning and monitor utilization trends

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license in New York
• Minimum of 2+ years of pediatric nursing experience
• Minimum of 2+ years of Utilization Management, Case Management, or Prior Authorization experience preferred
• Strong knowledge of MCG or InterQual guidelines
• Experience with medical necessity review and proficiency with EMR systems