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North Carolina Licensed Utilization Management Nurse

North Carolina Licensed Utilization Management Nurse

VirtualVocationsTallahassee, Florida, United States
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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

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Utilization Management Nurse • Tallahassee, Florida, United States

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