Job Summary

A professional services firm needs applicants for an opening for a Remote New York State Licensed Utilization Management Registered Nurse.

Must be able to:

• Perform 15-30 reviews per day
• Perform reviews for outpatient surgeries, and ancillary services
• Perform initial and concurrent review of inpatient admissions

Required Skills:

• 2+ years of utilization management experience
• Current unencumbered NY RN license with a minimum of 5+ years of acute clinical experience
• Strong knowledge of utilization management processes and industry best practice
• In depth knowledge and experience with the application of standard medical criteria sets
• Experience working in a managed care environment across multiple lines of business
• In-depth knowledge of current standard of medical practices and insurance benefit structures