State Licensed Utilization Management Nurse

Job Summary

Working remotely within Oregon, Washington, Idaho, or Utah, the full-time State Licensed Utilization Management Nurse will conduct utilization management reviews to ensure medical necessity and compliance, collaborating with interdisciplinary teams to promote quality and cost-effective healthcare outcomes.

Key responsibilities

• Conducts prospective, concurrent, and retrospective utilization management reviews to assess medical necessity
• Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed
• Collaborates with interdisciplinary teams to facilitate transitions of care and resolve issues while maintaining accurate documentation

Required qualifications

• Associate or Bachelor's Degree in Nursing or a related field
• Three years of experience in case management, utilization management, disease management, auditing, or retrospective review
• Current licensure or certification in a health or human services discipline allowing independent assessment
• Must hold a current unrestricted RN license for medical care management or a relevant advanced degree for behavioral health
• Licensure may be required in Idaho, Oregon, Utah, and Washington