State Licensed Utilization Management Nurse

Job Summary

A company is looking for a Medical Utilization Management Nurse to perform medical necessity and benefit review requests remotely.

Key Responsibilities

• Conducts clinical utilization reviews based on evidence-based guidelines and internal policies
• Collaborates with healthcare partners and provides referrals to various departments as needed
• Prepares cases for Medical Director oversight and communicates determinations to providers and members

Required Qualifications

• Current Licensed Practical Nurse (LPN) or Registered Nurse (RN) with active state licensure
• Weekend availability and ability to work independently
• Proficient in Microsoft Office and the Utilization Review process
• 2+ years of experience in a Utilization Management team within a managed care setting
• Experience with inpatient and outpatient reviews, including various specialties preferred