Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities

• Ensure adherence to PACE program service authorization policies and review service utilization
• Participate in concurrent and retrospective reviews of hospital and subacute admissions, driving efficient transitions of care
• Lead the provider appeals process for claim rejections in collaboration with the PACE Program's Medical Director

Required Qualifications

• 3 to 5 years of utilization management experience
• Current RN license
• Experience in risk-based integrated models of care
• Ability to utilize data for decision-making and collaboration
• Strong strategic thinking and leadership abilities