eNLC Licensed Clinical Nurse

Job Summary

A company is looking for a Utilization Management - Clinical Nurse to work from home.

Key Responsibilities

• Analyze clinical information and treatment plans for authorization requests
• Conduct telephonic reviews and create case summaries for medical necessity determinations
• Coordinate with providers and hospital staff to ensure compliance and continuity of care

Required Qualifications

• RN license in an eNLC state with multistate privileges
• 3+ years of nursing experience
• 1+ years of utilization management experience
• Familiarity with medical terminology and clinical documentation standards
• Proficiency in Microsoft Office and experience with healthcare systems