North Carolina Licensed Registered Nurse

Job Summary

To support the utilization management team, the full-time salaried North Carolina Licensed Registered Nurse will conduct clinical reviews for service authorization requests, ensuring medical necessity and quality while working remotely from home during standard business hours.

Key responsibilities

• Review and document requests for authorization of various healthcare services, ensuring compliance with contractual timelines
• Participate in staff meetings and complex case rounds, contributing to discharge planning and overall care coordination
• Utilize technology and resources effectively to support the utilization management process and communicate determinations to providers

Required qualifications

• Active and unrestricted RN License in North Carolina or a Nurse Licensure Compact (NLC) license
• Associate Degree in Nursing required; Bachelor's Degree in Nursing preferred
• Five years of clinical experience, including at least two years in acute care and experience in utilization management within a managed care setting
• Proficiency in Microsoft Office and familiarity with healthcare software programs
• Knowledge of primary care, behavioral health, and healthcare systems in North Carolina