Nurse Utilization Management Reviewer

Job Summary

A company is looking for an After Hours Utilization Management Reviewer.

Key Responsibilities

• Conduct utilization management reviews by assessing medical necessity and appropriateness of care
• Collaborate with healthcare providers to facilitate timely authorizations and optimize patient care
• Analyze medical records and clinical data to ensure compliance with regulatory and payer guidelines

Required Qualifications

• Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred
• Minimum of 3 years of diverse and independent clinical practice experience
• Minimum of 2 years of current experience performing prior authorization and concurrent reviews
• Current and unencumbered Nurse Licensure Compact (NLC)
• Current driver's license with the ability to obtain licensure in all markets across the enterprise