RN Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse for a contract to hire position.

Key Responsibilities

• Perform utilization review activities, including pre-certification, concurrent, and retrospective reviews
• Determine medical necessity of requests using appropriate medical criteria and evidence-based guidelines
• Document and communicate all utilization review activities and outcomes, including case communications

Required Qualifications

• Associates Degree
• RN with a current license to practice in the state of employment
• Current compact RN Licensure
• 2+ years of experience in managed care, Utilization Review, or Case Management, or 5+ years nursing experience
• Knowledge of medical terminology, ICD-9/ICD-10, and CPT