Registered Nurse Utilization Review

Job Summary

Collaborating with the Medical Director, the full-time Registered Nurse Utilization Review will manage care variance reduction, ensure timely discharges, and refer members to appropriate resources while working remotely.

Key responsibilities

• Assist in building and implementing care management review processes consistent with industry standards
• Collaborate with the medical management team to enhance healthcare outcomes for members through coaching and case management interventions
• Educate stakeholders to improve processes and strengthen network relationships

Required qualifications

• Current Registered Nurse license issued by the state or multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC)
• Three years of healthcare clinical experience
• Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN); currently enrolled in a BSN program with completion within three years of hire is preferred
• Experience in Medical Management for Medicare and/or Medicaid populations
• Utilization Management experience is a plus