Utilization Management Nurse Analyst

Job Summary

A company is looking for a UM Nurse Analyst (Remote).

Key Responsibilities

• Review payer Medical Policy Guidelines to identify medical necessity criteria
• Construct attestation questions using programming language that reflect medical necessity criteria
• Serve as a Subject Matter Expert and resource for engineering teams and developers

Required Qualifications

• Bachelor's degree in nursing
• At least 3+ years of experience in an outpatient Utilization Management program or equivalent clinical experience
• Familiarity with prior authorization submission practices
• General power user of technology and confident in navigating new applications
• Understanding of interpreting medical records to identify documentation of conditions and findings