State Licensed Utilization Management Nurse

Working remotely within Oregon, Washington, Idaho, or Utah, the full-time State Licensed Utilization Management Nurse will conduct utilization management reviews to ensure medical necessity and compliance, collaborating with interdisciplinary teams to promote quality and cost-effective healthcare outcomes. Key responsibilities Conducts prospective, concurrent, and retrospective utilization management reviews to assess medical necessity Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed Collaborates with interdisciplinary teams to facilitate transitions of care and resolve issues while maintaining accurate documentation Required qualifications Associate or Bachelor's Degree in Nursing or a related field Three years of experience in case management, utilization management, disease management, auditing, or retrospective review Current licensure or certification in a health or human services discipline allowing independent assessment Must hold a current unrestricted RN license for medical care management or a relevant advanced degree for behavioral health Licensure may be required in Idaho, Oregon, Utah, and Washington