A company is looking for a UM Clinical Specialist RN - Physical Health.
Key Responsibilities
Assess the medical necessity of services and conduct reviews against clinical guidelines
Ensure compliance with utilization management policies and quality improvement standards
Collaborate with other departments to monitor performance and provide technical assistance
Required Qualifications
Graduation from a State accredited school of nursing or an Associate's Degree in Nursing with five years of experience, or a Bachelor's degree in Nursing with three years of experience
Current, active, and unrestricted North Carolina clinical license as a Registered Nurse or a compact license
Preferred experience in Utilization Management
Knowledge of physical health and co-morbid health conditions
Proficient in the use of computer and multiple software programs
Clinical Specialist • Olympia Heights, Florida, United States