Nebraska Licensed Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse - Medicare.

Key Responsibilities

• Conduct clinical claim certification and authorization reviews to assess medical necessity and appropriateness of care
• Educate providers on member benefits, coverage, and utilization management processes
• Collaborate with healthcare providers to ensure high-quality, cost-effective care and facilitate transitions of care

Required Qualifications

• Associate's degree in nursing
• Three years of clinical practice experience in a healthcare setting
• Current, unrestricted Registered Nurse license from Nebraska or a participating state
• Experience in Medicare Advantage and Managed Care organizations
• Experience in discharge planning, utilization management, or case management