Licensed NICU Utilization Nurse

To support the delivery of quality care, the full-time Licensed NICU Utilization Nurse will coordinate member care from pre-admission through discharge, ensuring compliance with managed care policies while working remotely. Key responsibilities: Initiating the continuum of care process for neonatal admissions Interacting with hospital staff to collect clinical information for medical necessity determinations Coordinating discharge planning needs for newborns from intensive care nurseries Required qualifications: Registered Nurse (RN) with a current, unrestricted license Three or more years of clinical experience as a nurse in a Level III or Level IV NICU Three or more years of experience in concurrent review or discharge planning within a health plan or acute facility Experience with Interqual and/or MCG preferred Strong computer skills and experience with data entry into a database or EHR