State Licensed Utilization Review RN
Job Summary
To support effective utilization management, the full-time State Licensed Utilization Review RN will examine medical records, conduct clinical reviews for authorization, and collaborate with interdisciplinary teams to optimize reimbursement and patient care in a remote setting.
Key responsibilities
- Review and assess clinical information to support utilization management decisions based on medical documentation
- Facilitate communication with payors regarding medical necessity and authorization processes
- Collaborate with clinical appeals and physician advisors to manage concurrent denials and ensure appropriate patient status determination
Required qualifications
- Current Registered Nurse license issued by the state or a multi-state RN license through the enhanced Nurse Licensure Compact (eNLC)
- Three years of healthcare clinical experience
- Bachelor's Degree in Nursing or currently enrolled in a BSN program with completion within three years of hire
- Experience in medical management for Medicare and/or Medicaid populations
- Utilization management experience
Complete Job Description
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