Utilization Management Nurse RN

Job Summary

A company is looking for a Utilization Management Nurse RN - Remote.

Key Responsibilities

• Conduct timely and accurate admission, concurrent, and discharge reviews to determine medical necessity and appropriate level of care
• Document utilization review findings in electronic medical records and utilization management systems
• Monitor and escalate potential or actual payer denials for timely resolution

Required Qualifications

• Active, unrestricted RN or LPN license in the state of residency
• 3+ years of experience in utilization review or case management in an acute care setting
• Solid knowledge of InterQual/MCG criteria, CMS regulations, and payer guidelines
• Proficiency in electronic medical records and utilization management software