State Licensed Care Management Nurse

Job Summary

A company is looking for a Utilization and Care Management Nurse to provide care management and utilization reviews to meet members' healthcare needs.

Key Responsibilities

• Conduct utilization management reviews to ensure medical necessity and compliance with standards of care
• Participate in care management to coordinate healthcare needs for members post-discharge
• Collaborate with interdisciplinary teams to facilitate transitions of care and resolve issues

Required Qualifications

• Associate or Bachelor's Degree in Nursing or related field
• 3 years of experience in case management, utilization management, or similar fields
• Licensure or certification in a relevant health or human services discipline
• Current unrestricted RN license for medical care management or a Bachelor's degree in a health-related field
• May require licensure in Idaho, Oregon, Utah, and Washington