Nevada Licensed Utilization Manager

To ensure timely access to care, the full-time remote Nevada Licensed Utilization Manager will manage prior authorizations and concurrent review authorizations, leveraging clinical knowledge and relationship-building skills to facilitate patient transitions and streamline the authorization process. Key responsibilities Oversees the authorization process by reviewing medical records and coordinating with referring hospitals and case management teams Generates written appeals for denied authorizations, utilizing clinical and regulatory knowledge to advocate for patients Maintains effective communication with stakeholders, ensuring timely processing of authorizations and compliance with regulatory standards Required qualifications Postsecondary certificate, diploma, or program graduation from an accredited school of nursing or an Associate's Degree in healthcare Preferred Bachelor's Degree in healthcare or a related field Three or more years of experience in a healthcare setting, preferably in managed care or utilization review Healthcare licensure may be preferred unless required by the state of practice Strong knowledge of medical necessity justification and regulatory compliance guidelines