Maine Licensed Utilization Review Nurse

Job Summary

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 participate in quality initiatives and process improvements

Required Qualifications

• Unrestricted state license as a Registered Nurse required; BSN preferred
• 3+ years of clinical nursing experience
• Utilization management experience in a managed care or hospital environment required
• Certification in managed care nursing or care management desired (CMCN or CCM)