Texas Licensed Nurse Practitioner - job 1 of 5

Job Summary

A company is looking for a Certified Nurse Practitioner, Utilization Management.

Key Responsibilities:

• Perform comprehensive utilization reviews for various healthcare services
• Conduct prior authorization reviews based on clinical criteria and medical policies
• Evaluate medical records to assess medical necessity and issue denials when appropriate

Qualifications:

• Active and unrestricted Certified Nurse Practitioner (CNP) license in Texas, Florida, and Georgia
• Master's or Doctor of Nursing Practice (MSN/DNP) degree from an accredited program
• 3-5 years of clinical experience as a Nurse Practitioner
• Experience in utilization review and medical necessity determinations
• Strong understanding of healthcare delivery systems and medical terminology