Washington State Licensed UM Nurse

Job Summary

Working remotely on a full-time basis, the Washington State Licensed UM Nurse will manage concurrent utilization management activities, ensuring compliance and optimal reimbursement while serving as a resource for clinical and support staff.

Key responsibilities

• Facilitate Utilization Review compliance and oversee the UR process for assigned licensed facilities
• Provide guidance on complex cases and assist with daily assignments for UM clinical and support staff
• Conduct accurate admission and continued stay reviews based on CMS regulations and UM criteria

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