Registered Nurse - Utilization Management
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Job Summary
Seeking an experienced Registered Nurse - Utilization Management, the full-time remote position will manage case reviews, support coverage determinations, and coordinate care to ensure members receive appropriate healthcare services.
Key responsibilities
- Review clinical information and apply evidence-based criteria for utilization and coverage recommendations
- Collaborate with providers and healthcare teams to support treatment plans and care coordination
- Identify opportunities to enhance healthcare quality, outcomes, and benefit utilization
Required qualifications
- Active, unrestricted RN license in the state of residence
- 2+ years of RN experience in an adult acute care or critical care setting
- Associates Degree in Nursing
- Proficiency in navigating multiple computer systems
- Strong communication and critical thinking skills
Complete Job Description
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