Job Summary
An IT business services company needs applicants for an opening for a Remote Licensed Utilization Review Nurse.
Core Responsibilities Include:
- Evaluating clinical information submitted by providers against plan review criteria and benefit guidelines
- Documenting all pertinent case information and dispositions for approvals and denials
- Utilizing clinical information to determine if criteria for medical necessity and benefit guidelines are met
Position Requirements Include:
- At least 2 years of clinical experience in a hospital, acute care, direct care or utilization management
- Preferred: 2+ years of UM/CM experience; One of the following certifications: MCG, ACM, CCM, CMC, and/or CMCN
