Registered Nurse Case Manager

Job Summary

A company is looking for a Utilization Management & Complex Case Manager, Registered Nurse (FT, Remote).

Key Responsibilities:

• Review authorization requests to ensure medical necessity and appropriate level of care
• Conduct comprehensive assessments and develop case management care plans in collaboration with beneficiaries and healthcare providers
• Monitor and evaluate care plans, making necessary revisions to achieve desired outcomes

Required Qualifications:

• Current, unrestricted RN license in state of residence with multi-state privileges
• 3+ years of experience as a nurse in a clinical setting
• 2+ years of experience performing utilization review for a health plan or inpatient facility
• 1+ year of experience as a case manager for a health plan or inpatient facility
• Strong technical proficiency with MS Office Suite and ability to navigate multiple systems