Registered Nurse Case Manager

Job Summary

A company is looking for a Telephonic Utilization Management & Complex Case Manager, Registered Nurse.

Key Responsibilities:

• Review authorization requests using clinical judgment and evidence-based criteria
• Conduct comprehensive assessments and develop case management care plans
• Collaborate with multidisciplinary teams to ensure continuity of care and optimal outcomes

Required Qualifications:

• Current, unrestricted RN license in state of residence with multi-state privileges
• 3+ years of experience as a nurse in a clinical setting
• 2+ years of experience performing utilization review for a health plan or inpatient facility
• 1+ year of experience as a case manager for a health plan or inpatient facility
• Strong technical proficiency with MS Office Suite and ability to navigate multiple systems