Virginia Licensed Utilization Review Nurse

Job Summary

A company is looking for a Commercial Utilization Review Nurse/RN for a remote position in Virginia.

Key Responsibilities

• Conduct utilization management services including prior authorization and various types of reviews
• Manage appeals for denied services and facilitate care transitions
• Ensure compliance with medical policies and regulatory requirements

Required Qualifications

• Bachelor's Level Degree in Nursing preferred
• Registered Nurse License (RN) - Compact/Multi-State License required
• Minimum 3 years of acute care clinical experience
• Previous Utilization Review and Case Management experience preferred
• Knowledge of InterQual or Milliman and NCQA preferred