Florida Licensed Utilization Management Nurse

Job Summary

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

Key Responsibilities

• Assess medical service requests for necessity and appropriateness using evidence-based clinical guidelines
• Collaborate with healthcare providers to inform utilization management decisions and ensure compliance with regulations
• Monitor utilization trends and contribute to quality improvement initiatives for optimizing medical outcomes

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