RN Utilization ManagementVirtualVocations • Reno, Nevada, United States

RN Utilization Management

VirtualVocations • Reno, Nevada, United States

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A company is looking for an RN Utilization Management remote.

Key Responsibilities

Participates in designated committees and task forces related to the Utilization Management Program

Coordinates with various departments including utilization review, case management, and claims regarding case management issues

Documents and communicates quality concerns related to members to appropriate staff

Required Qualifications

Associate or Bachelor's Degree in Nursing

Current license to practice as a Registered Nurse in the home state or a compact nursing license

5-7 years of clinical nursing experience, with at least 2 years in utilization review or case management

Experience in an HMO insurance setting is preferred

Ability to conduct claim reviews for appropriate claims processing

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