North Carolina Licensed Registered Nurse

Job Summary

Responsible for completing clinical reviews for appropriateness and medical necessity, the full-time North Carolina Licensed Registered Nurse will work remotely, managing service authorization requests and collaborating with a multidisciplinary team while ensuring coverage during weekends and holidays.

Key responsibilities

• Review requests for authorization of services and document decisions within the managed care information system
• Participate in staff meetings and complex case rounds, and perform discharge planning for safe enrollee discharges
• Communicate determinations to providers and coordinate activities of the utilization management process

Required qualifications

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