Job Summary
An insurance company has an open position for a Remote Registered Nurse Utilization Manager.
Core Responsibilities Include:
- Engaging members to support the appropriate level of care
- Working closely with providers to assure members are being provided the highest quality of care
- Reviewing proposed medical care cases for medical necessity against established CMS Coverage Guidelines
Qualifications for this position include:
- Travel: Yes, 10 % of the Time
- BSN or Bachelor's degree in a related field
- Active RN license in the state in which the nurse practices
- Minimum of 2 years prior clinical experience in an acute and/or post -acute setting
- Proficient with computer skills particularly Excel, Word and PowerPoint
- Possess ability to communicate well both telephonic and face to face
