Nebraska Licensed Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities

• Conduct clinical claim certification and authorization reviews to assess medical necessity and appropriateness of treatment settings
• Educate healthcare providers on member benefits, coverage, and utilization management processes
• Collaborate with healthcare providers and internal teams to ensure high-quality, cost-effective care and support discharge planning

Required Qualifications

• Associate's Degree in Nursing
• Three (3) years of clinical practice experience in a healthcare setting
• Current, unrestricted Registered Nurse license from Nebraska or a participating consortium state
• Ability to work rotating weekend/holiday shifts as needed
• Demonstrated experience in Medicare Advantage and Managed Care organizations is preferred