Working remotely within Oregon, Washington, Idaho, or Utah, the full-time Licensed Utilization Management Nurse will conduct utilization management reviews to ensure medical necessity and compliance, collaborating with interdisciplinary teams to facilitate care transitions and improve quality outcomes. Key responsibilities Conducts prospective, concurrent, and retrospective utilization management reviews to assess medical necessity and adherence to policies Applies clinical expertise and evidence-based criteria for decision-making, consulting with physician advisors as necessary Collaborates with interdisciplinary teams and case management to address care transitions and resolve issues effectively Required qualifications Associate or Bachelor's Degree in Nursing or a related field At least 3 years of experience in case management, utilization management, or related fields Current licensure or certification in a health or human services discipline allowing independent assessments May require licensure in Idaho, Oregon, Utah, and Washington Must possess a current unrestricted RN license for medical care management or a relevant higher degree in health or human services
Licensed Utilization Management Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.