Registered Nurse Utilization Management

Job Summary

A company is looking for a Utilization Management Nurse Consultant (Remote).

Key Responsibilities

• Evaluate outpatient and inpatient services requiring precertification and concurrent review using clinical criteria
• Conduct clinical reviews and collaborate with healthcare providers to gather necessary information
• Authorize services based on established guidelines or escalate to Medical Directors as needed

Required Qualifications

• Active unrestricted state Registered Nurse licensure in state of residence
• Minimum 5 years of relevant experience in Nursing
• At least 1 year of Utilization Management experience in concurrent review or prior authorization
• Proficient with phone systems and clinical documentation tools
• Commitment to attend a mandatory 3-week training with 100% participation