Nebraska Licensed Utilization Management RN

To support the clinical and financial coordination of patient care, the full-time Nebraska Licensed Utilization Management RN will conduct utilization reviews, collaborate with healthcare teams, and manage denials and appeals processes in a 100% remote setting. Key responsibilities Perform utilization review activities, including concurrent and retrospective reviews, to determine medical necessity Collaborate with healthcare providers to manage patient length of stay and ensure compliance with insurance authorizations Participate in the denials and appeals process by researching issues and providing necessary documentation for appeals Required qualifications Current Registered Nurse licensure from the State of Nebraska or an approved compact state Two years of clinical experience and preferred experience in utilization management and the denials process Basic Life Support (BLS) certification required Knowledge of governmental and third-party payer regulations related to patient hospitalization Ability to analyze clinical denial data to identify trends and recommend process improvements