To support effective utilization management, the full-time State Licensed Utilization Review RN will examine medical records, conduct clinical reviews for authorization, and collaborate with interdisciplinary teams to optimize reimbursement and patient care in a remote setting. Key responsibilities Review and assess clinical information to support utilization management decisions based on medical documentation Facilitate communication with payors regarding medical necessity and authorization processes Collaborate with clinical appeals and physician advisors to manage concurrent denials and ensure appropriate patient status determination Required qualifications Current Registered Nurse license issued by the state or a multi-state RN license through the enhanced Nurse Licensure Compact (eNLC) Three years of healthcare clinical experience Bachelor's Degree in Nursing or currently enrolled in a BSN program with completion within three years of hire Experience in medical management for Medicare and/or Medicaid populations Utilization management experience
State Licensed Utilization Review RN in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.