Registered Nurse Utilization Specialist

Job Summary

A company is looking for a Utilization Management Specialist (Home-Based) - Prior Authorization.

Key Responsibilities

• Conduct medical necessity reviews and perform utilization management activities in compliance with accreditation requirements
• Manage patient chart reviews, insurance coverage, prior authorizations, and collaborate with healthcare teams for resource utilization
• Assist in monitoring resource utilization, prepare reports, and ensure compliance with professional standards and regulations

Required Qualifications

• Bachelor's degree in nursing preferred; graduate from a nationally accredited nursing program required
• Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing
• Maintains required department-specific competencies and certifications