West Virginia Licensed RN
Job Summary
Collaborating with the Medical Director, the full-time Utilization Management RN will drive care variance reduction, ensure timely discharges, and refer members to appropriate resources while working remotely.
Key responsibilities
- Assist in building and implementing care management review processes, including Prior Authorization and Concurrent Reviews
- Ensure interventions are collaborative and focus on maximizing member healthcare outcomes
- Educate stakeholders to improve processes and strengthen network relationships
Required qualifications
- Current Registered Nurse license issued by West Virginia or a multi-state RN license through the enhanced Nurse Licensure Compact (eNLC)
- Three years of healthcare clinical experience
- Bachelor's Degree in Nursing or Associate of Science in Nursing; currently enrolled in a BSN program with completion within three years is acceptable
- Experience in Medical Management for Medicare and/or Medicaid populations
- Utilization Management experience
Complete Job Description
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