Job Summary
A healthcare provider is filling a position for a Remote Utilization Management Nurse.
Candidates will be responsible for the following:
- Determining medical appropriateness of inpatient and outpatient services
- Identifying solutions to problems and non-standard requests
- Collaborating with staff, physicians, care/service coordinators, and medical directors
Skills and Requirements Include:
- Minimum of 5+ years of acute clinical experience
- Current unencumbered RN license
- 2+ years of utilization management experience
- Experience performing utilization management for Medicare Advantage, Managed Medicaid, Dual SNP, & Commercial Lines of Business
- In-depth knowledge of current standard of medical practices and insurance benefit structures
