RN Med Management Nurse

Job Summary

A company is looking for a Med Mgmt Nurse to evaluate medically complex cases requiring advanced nursing judgment and clinical reasoning.

Key Responsibilities

• Analyze member clinical presentations and determine medical necessity using critical thinking and clinical criteria
• Interface with healthcare providers to assess the scope and relevance of requested services
• Provide recommendations on alternative types, places, or levels of care as needed

Qualifications

• Associate's degree in nursing required (BSN preferred)
• Minimum of 4 years in care/case management
• At least 2 years' experience in clinical review, utilization review, or managed care
• Current, active, and unrestricted RN license in applicable U.S. state(s) or territories
• Multi-state licensure required if providing services across multiple jurisdictions