Washington State Licensed UM Nurse

Job Summary

To support a defined MHS Licensed Facility, the full-time salaried Utilization Management Specialist Nurse will manage concurrent utilization management activities, ensuring compliance and optimal reimbursement through oversight of admission and continued stay reviews, while working remotely.

Key responsibilities

• Facilitate Utilization Review compliance and oversee the UR process for assigned licensed facilities
• Provide guidance and support to clinical and support staff on complex cases and daily assignments
• Collaborate with healthcare teams and management to ensure timely and accurate patient reviews

Required qualifications

• Bachelor's degree in Nursing or obtained within five years from the initial date of hire; RN with 15+ years of service may be considered in lieu of education agreement
• Current Registered Nurse license in Washington State or Multistate License endorsement (MLS)
• Five years of clinical experience required; utilization management and/or insurance industry experience preferred
• Advanced Degree in Nursing (MSN, PhD, DNP, ARNP) preferred