Working remotely in a full-time capacity, the Nebraska Licensed Utilization Nurse will conduct clinical claim certification reviews, educate providers on member benefits, and facilitate transitions of care to ensure members receive high-quality, medically necessary care. Key responsibilities Conduct clinical claim certification and authorization reviews to assess medical necessity and appropriateness of treatment settings Educate healthcare providers about member benefits and utilization management processes Collaborate with healthcare providers and internal teams to promote positive member outcomes and optimize resource use Required qualifications Associate's degree in nursing Three years of clinical practice experience in a healthcare setting Active, unrestricted Registered Nurse license from Nebraska or a participating consortium state Experience in Managed Care organizations, including Medicare or Commercial Insurance Experience in discharge planning, utilization management, or case management
Nebraska Licensed Utilization Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.