Georgia Licensed Utilization Review Nurse

To support complex case evaluations, the full-time contract Georgia Licensed Utilization Review Nurse will review high-complexity clinical cases remotely, applying advanced nursing judgment and collaborating with healthcare providers and Medical Directors. Key responsibilities Apply advanced nursing judgment and clinical guidelines to evaluate clinical data and determine medical necessity Interface with healthcare providers to assess members' symptoms and ensure appropriate care levels Consult with Medical Directors on complex cases and collaborate on discharge planning with case management nurses Required qualifications Associate's Degree in Nursing (ADN) required Active and unrestricted Registered Nurse (RN) license in applicable state(s) or U.S. territories 4+ years of care management or case management experience combined with 2+ years of clinical, utilization review, or managed care experience