Job Summary
A company is looking for a Utilization Management Nurse for a contract to hire position.
Key Responsibilities
- Perform utilization review activities, including pre-certification, concurrent, and retrospective reviews
- Determine medical necessity of requests using appropriate medical criteria and evidence-based guidelines
- Document and communicate all utilization review activities and outcomes, including case communications
Required Qualifications
- Associates Degree
- RN with a current license to practice in the state of employment
- Current compact RN Licensure
- 2+ years of experience in managed care, Utilization Review, or Case Management, or 5+ years nursing experience
- Knowledge of medical terminology, ICD-9/ICD-10, and CPT
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