Job Summary
A healthcare software company is filling a position for a Remote Utilization Management Registered Nurse.
Candidates will be responsible for the following:
- Completing medical necessity and level of care reviews for requested services
- Educating providers on utilization and medical management processes
- Entering and maintaining pertinent clinical information in various medical management systems
Qualifications for this position include:
- Active LPN or RN state license
- Solid understanding of peer review criteria, NCQA, CMS
- Experience reading clinical documentation to identify/extract service requirement
