Utilization Management RN

Job Summary

A company is looking for a Utilization Management RN.

Key Responsibilities:

• Evaluate the efficiency, appropriateness, and medical necessity of medical services
• Review evidence-based criteria and jurisdictional guidelines to make final determinations
• Educate customers or providers, problem-solve unique customer issues, and maintain confidentiality of customer information

Required Qualifications:

• Bachelor of Science Degree in Nursing
• 1 or more years of related work experience
• Active license as an RN in the State of Wisconsin or a valid multi-state compact license
• 5 or more years of experience as an RN in a varied clinical setting with 2 or more years in Managed Care
• Working knowledge of CPT/ICD 10/HCPCS codes