North Carolina Licensed Utilization Nurse

Job Summary

A company is looking for a Utilization Management Nurse to perform medical necessity and benefit review requests while working remotely.

Key Responsibilities

• Conducts clinical utilization reviews based on evidence-based guidelines and internal policies
• Collaborates with healthcare partners and refers cases to appropriate departments as needed
• Prepares cases for Medical Director oversight and communicates determinations to providers and members

Required Qualifications

• Current Licensed Practical Nurse (LPN) with active state licensure
• Proficient in Microsoft Office applications
• 2+ years of experience in a Utilization Management team within a managed care setting
• Experience with inpatient and outpatient reviews preferred
• Working knowledge of URAC and NCQA standards