Job Summary
A company is looking for a Utilization Management Nurse for Behavioral Health (Remote) position.
Key Responsibilities
- Conduct utilization reviews to assess the appropriateness of patient care based on illness severity and service intensity
- Monitor patient charts and treatment plans, ensuring compliance with applicable policies and regulations
- Consult with healthcare providers and stakeholders as necessary to facilitate patient care
Required Qualifications, Training, and Education
- Bachelor's degree in Nursing from an accredited institution
- Five years of nursing experience, including two years in utilization or case management in a hospital setting
- Preferred prior leadership experience and evidence of committee involvement in a healthcare setting
- Licensure as a registered nurse in South Carolina or a compact state
- Familiarity with InterQual and/or MCG screening criteria is desired
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