North Carolina Licensed Utilization Management Nurse

A company is looking for a Utilization Management Nurse.

Key Responsibilities

Performs clinical utilization reviews using evidence-based guidelines and internal policies

Collaborates with healthcare partners to ensure timely review of services and care

Communicates determinations to providers and / or members in compliance with regulatory requirements

Required Qualifications

Current Registered Nurse (RN) with active state licensure

Proficient in Microsoft Office applications

2+ years' experience in a Utilization Management team within a managed care setting

Experience with both inpatient and outpatient reviews preferred

Working knowledge of URAC and NCQA standards