A company is looking for a Case Manager - Utilization Review.
Key Responsibilities
Conduct timely medical necessity reviews using medical coverage guideline criteria
Present cases that do not meet clinical criteria to the Medical Director
Communicate with payers to ensure timely clinical review submissions
Required Qualifications, Training, and Education
Graduate from an accredited school of nursing required; Bachelor of Science in Nursing preferred
Three years of clinical nursing experience in an acute care facility
Current RN License issued by the Oklahoma State Board of Nursing or a multistate Compact RN License
Experience with utilization review or case management preferred
Case management certification preferred
Case Manager • Omaha, Nebraska, United States