North Carolina Licensed Utilization Nurse

Job Summary

A company is looking for a Utilization Management Nurse, Prior Authorization.

Key Responsibilities

• Perform medical necessity reviews and first level determinations for prior authorization requests
• Collaborate with healthcare partners to ensure timely review of services and care
• Prepare and present cases to the Medical Director for oversight and necessity determinations

Required Qualifications

• Current licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN) with active state licensure
• 2+ years' experience in a Utilization Management team within a managed care setting
• Proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint)
• Working knowledge of URAC and NCQA
• Experience with outpatient reviews in various medical fields preferred