Registered Nurse - Utilization Management Remote

Location: Remote
Compensation: Hourly
Staff Reviewed: Mon, Feb 05, 2024
This job expires in: 3 days

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

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