Description
The Utilization Management Nurse performs clinical reviews of prior approvals, network exceptions, benefit inquiries, inpatient and outpatient services, and other contracted lines of business. The role evaluates medical necessity using evidence-based criteria, clinical guidelines, corporate policies, and standards; promotes appropriate, high-quality, cost-effective care; and collaborates with healthcare providers and internal staff. The position requires an active RN license, at least four years of clinical nursing experience in medical-surgical, surgical, intensive care, or critical care nursing, and a bachelor's degree in nursing is preferred. It is a regular, remote work-from-home role available in Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, and Minnesota, with a hiring range of $66,260 to $84,030.
