Description
The RN 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 and corporate guidelines, and company policies; promotes appropriate, cost-effective care; and provides utilization management services during regular workdays and scheduled weekends. The position is remote within specified states, requires an active RN license and at least four years of clinical nursing experience including utilization management or medical review, and offers a $5,000 premium for the schedule.
