Wisconsin Licensed Utilization Management RN

Job Summary

A company is looking for a Utilization Management RN (Registered Nurse).

Key Responsibilities

• Evaluate the efficiency, appropriateness, and medical necessity of medical services and procedures
• Review medical services using evidence-based criteria and authorize requested services as appropriate
• Document case summaries and refer questionable cases to medical directors for further review

Required Qualifications

• Registered Nurse (RN) with current licensure in Wisconsin
• 4 or more years of experience as a Registered Nurse in varied clinical settings
• 2 or more years of experience in Managed Care, including prior authorization and utilization review
• Strong knowledge of current medical practices, medical coding, and trends in care
• Familiarity with health plan operations and payer/provider relationships