Florida Licensed Utilization Management Nurse

Job Summary

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

Key Responsibilities

• Assess requests for medical services for medical necessity and adherence to clinical guidelines
• Collaborate with healthcare providers to make informed utilization management decisions
• Monitor and track medical service utilization to identify trends and improve cost-efficiency and quality of care

Required Qualifications

• Registered Nurse (RN) license in good standing within state of practice
• Bachelor's degree in Nursing or a related field preferred
• 2 years of experience in Utilization Management
• Previous training in negotiations, Quality Assurance, and Case Management outcomes
• Strong knowledge of evidence-based clinical guidelines and medical terminology