Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities

• Coordinate and facilitate correct identification of patient status
• Conduct concurrent and retrospective reviews and support the medical necessity denial and appeal process
• Collaborate with healthcare team members and participate in clinical performance improvement activities

Required Qualifications

• Minimum Licensed Practical Nurse, A.A.S. in Nursing, or BSN
• 3-5 years of experience in an acute care hospital setting or equivalent in utilization management and case management
• Knowledge of Medicare rules and regulatory standards
• Familiarity with Medicare and Medicaid UM regulations and denial management
• Computer skills in word processing, database management, and spreadsheet applications are desirable