North Dakota Licensed Utilization Specialist

Job Summary

A company is looking for a Utilization Management Specialist (Home-Based) - Prior Authorization.

Key Responsibilities

• Conduct medical necessity reviews and manage utilization management activities
• Collaborate with healthcare team members to promote resource utilization and documentation improvement
• Monitor compliance with accreditation and regulatory requirements while preparing reports and maintaining records

Required Qualifications, Training, and Education

• Bachelor's degree in nursing preferred
• Graduate from a nationally accredited nursing program required
• Currently holds an unencumbered registered nurse (RN) license
• Maintains required department-specific competencies and certifications