Utilization Management Nurse

Job Summary

A company is looking for a Pre-Certification/Utilization Management Nurse.

Key Responsibilities:

• Conduct utilization and quality management activities in accordance with policies and procedures
• Perform clinical reviews and authorize services based on medical necessity criteria
• Collaborate with Intake Coordinators and Case Managers to ensure timely care coordination

Qualifications:

• Current, unrestricted RN license in a state or territory of the United States
• 2-3 years of experience in utilization review, quality assurance, or related fields preferred
• Two years of hospital-based nursing experience required
• HCQM, HRM, or similar certification preferred
• Working knowledge of utilization management or case management preferred