Remote Utilization Management Nurse

Job Summary

A nonprofit healthcare company needs applicants for an opening for a Remote Utilization Management Nurse.

Candidates will be responsible for the following:

• Reviewing utilization management conducted prior to a patient’s admission, stay, or other service or course of treatment
• Reviewing conducted after services (including outpatient procedures and services) have been provided to the patient
• Applying clinical expertise & judgment to ensure compliance with medical policy, medical necessity guidelines & standards of care

Qualifications Include:

• Knowledge of health insurance industry trends, technology & contractual arrangements
• Familiarity with health care documentation systems
• General computer skills (including use of Microsoft Office, Outlook, internet search)
• Ability to interpret policies and procedures and communicate complex topics effectively