New Mexico Licensed Utilization Nurse
A company is looking for a Utilization Management Nurse Specialist. Key Responsibilities Conduct clinical reviews to ensure services meet clinical criteria and are delivered appropriately Validate and interpret medical documentation using evidence-based criteria, and consult with medical directors on cases Perform retrospective medical claims audits and streamline the prior authorization process to enhance patient outcomes Required Qualifications Active New Mexico Nursing license 3-5 years of nursing experience and 1-3 years in utilization management, prior authorization, or case management Strong knowledge of healthcare terminology, clinical guidelines, and insurance authorization processes Proficiency with EHR and case management software For LPNs: similar experience and qualifications as above will be considered
A company is looking for a Utilization Management Nurse Specialist.
Key Responsibilities
Conduct clinical reviews to ensure services meet clinical criteria and are delivered appropriately
Validate and interpret medical documentation using evidence-based criteria, and consult with medical directors on cases
Perform retrospective medical claims audits and streamline the prior authorization process to enhance patient outcomes
Required Qualifications
Active New Mexico Nursing license
3-5 years of nursing experience and 1-3 years in utilization management, prior authorization, or case management
Strong knowledge of healthcare terminology, clinical guidelines, and insurance authorization processes
Proficiency with EHR and case management software
For LPNs: similar experience and qualifications as above will be considered
