Utilization Management Nurse

A company is looking for a Utilization Management Nurse.

Key Responsibilities

Perform concurrent and retrospective reviews of healthcare services to ensure quality and cost-effective care

Engage with providers for proactive discharge and transition planning, and manage prior authorization processes

Coordinate interdisciplinary approaches to support continuity of care and identify opportunities for cost savings

Required Qualifications

Minimum 2 years clinical experience as RN, LPN / LVN required

Minimum 1-year managed care or equivalent health plan experience preferred

Experience in health plan utilization management and facility concurrent review required

Active unrestricted Nursing license required

Experience with InterQual or MCG authorization criteria preferred