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
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