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RN Utilization Management Nurse

7/11/2025

No location specified

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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