Utilization Management Nurse

Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely. Primary responsibilities include performing clinical utilization reviews, identifying potential quality of care issues, and communicating determinations to providers and/or members.

Requirements

• Current Licensed Practical Nurse (LPN) with state licensure
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Ability to work independently
• Detail oriented and strong organizational and time management skills
• Adaptive to a high pace and changing environment
• Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review
• Proficient in MCG and CMS criteria sets
• 2+ years’ experience in a UM team within managed care setting
• 3+ years’ experience in clinical nurse setting
• TPA Experience preferred

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan
• Visa Sponsorship
• Four Day Work Week
• Generous Parental Leave
• Tuition Reimbursement
• Relocation Assistance