Utilization Management Nurse, RN
Job Summary
Managing the Utilization Management process, the full-time remote Utilization Management Nurse, RN will ensure appropriate and cost-effective healthcare delivery by conducting reviews, collaborating with healthcare professionals, and promoting quality care for plan participants.
Key responsibilities
- Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective assessments
- Collaborate with internal teams and healthcare providers to apply UM criteria and promote cost-effective outcomes
- Ensure compliance with regulatory standards and maintain accurate records of UM activities while safeguarding confidentiality
Required qualifications
- 3+ years of clinical nursing experience
- Active, unrestricted RN license in the state of residence
- Experience in a fast-paced, detailed, and deadline-driven environment
- Ability to maintain confidentiality and handle sensitive information
- Strong problem-solving and organization skills
Complete Job Description
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