Utilization Management RN

About This Role

Review approximately 20 cases daily for medical necessity and advocate for patient protections against unnecessary hospital admissions. Follow established procedures to complete authorizations and collaborate with a team of nurses.

Responsibilities

• Review approximately 20 cases daily for medical necessity
• Advocate for and protect members from unnecessary hospital admissions
• Follow established procedures and processes to complete authorizations
• Collaborate with a team of nurses to assist each other and complete cases

Requirements

• 3+ years of utilization management, concurrent review, prior authorization, utilization review, case management, and discharge planning
• Active RN Compact License

Qualifications

• 3+ years of utilization management, concurrent review, prior authorization, utilization review, case management, and discharge planning

Benefits