Maine Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse - Remote.

Key Responsibilities :

Review prior authorization requests for medical necessity and manage claims disputes

Collaborate with healthcare providers and team members to coordinate care and establish discharge plans

Complete documentation of reviews and decisions in compliance with regulations and standards

Required Qualifications :

Unrestricted state license as a Registered Nurse; BSN preferred

3+ years of clinical nursing experience

Utilization management experience in a managed care or hospital environment

Certification in managed care nursing or care management desired (CMCN or CCM)