Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities:

• Perform pre-service and post-service UM authorization reviews utilizing federal and state mandates
• Work with non-clinical team to obtain additional clinical information, as needed
• Approve requests that meet eligibility, benefit, and medical necessity criteria

Required Qualifications:

• Active, Licensed Vocational Nurse, or Licensed Practical Nurse license
• Minimum of 3 years of nursing in an acute or outpatient setting
• Minimum of 2 years of UM experience in a managed care, payor environment
• Experience with Medicare and Medicaid (not required, but highly desirable)
• Experience with UM authorizations and appeals for DMEPOS (not required, but highly desirable)