Registered Nurse - Utilization Management Remote

Job Summary

A company is looking for a Registered Nurse - Utilization Management (REMOTE).

Key Responsibilities:

• Conduct telephonic reviews for inpatient facilities for both concurrent and retrospective reviews for appropriateness of treatment setting reviews to ensure compliance with applicable criteria
• Process Prior Authorization requests for medical necessity of Outpatient services including Rehab, Home Health and DME
• Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care

Qualifications:

• Active Registered Nurse License, Multi-State (AZ/FL Included)
• 3+ Years of Experience in Concurrent Review, Inpatient Services
• 3+ Years of Concurrent Review with a Health Plan
• Strong Experience with InterQual and MGM Guidelines