Remote RN Utilization Management

Job Summary

A company is looking for a Telephonic Utilization Management & Case Management Operations Registered Nurse, Remote.

Key Responsibilities

• Review authorization requests using clinical judgment to ensure medical necessity and appropriate level of care
• Conduct comprehensive assessments and develop case management care plans in collaboration with beneficiaries and healthcare providers
• Monitor and evaluate care plans to ensure effectiveness and achieve desired outcomes

Required Qualifications

• Current, unrestricted RN license with multi-state privileges or ability to obtain them
• 3+ years of experience as a nurse in a clinical setting
• 2+ years of experience performing utilization review for a health plan or inpatient facility
• 1+ year of experience as a case manager for a health plan or inpatient facility
• Strong technical proficiency with MS Office Suite and ability to navigate multiple systems