New York Licensed Utilization Management Nurse

A company is looking for a Utilization Management Nurse specializing in Managed Long-Term Care (MLTC). Key Responsibilities Conduct standard and expedited UM clinical reviews for inpatient, outpatient, and custodial care services for MLTC members Manage the UM process, including clinical reviews, processing denials, and providing notifications to members and providers Participate in interdisciplinary team meetings and present cases for medical reviews Required Qualifications Minimum 1-2 years of experience in Utilization Management focusing on Medicaid/MLTC members Active New York State LPN or RN license Strong computer skills and familiarity with MCG guidelines Experience in handling fast-paced UM processes and adhering to strict turnaround times Fluency in Spanish, Bengali, or Mandarin is preferred but not mandatory

Mar 10, 2025 - 17:09

A company is looking for a Utilization Management Nurse specializing in Managed Long-Term Care (MLTC). Key Responsibilities Conduct standard and expedited UM clinical reviews for inpatient, outpatient, and custodial care services for MLTC members Manage the UM process, including clinical reviews, processing denials, and providing notifications to members and providers Participate in interdisciplinary team meetings and present cases for medical reviews Required Qualifications Minimum 1-2 years of experience in Utilization Management focusing on Medicaid/MLTC members Active New York State LPN or RN license Strong computer skills and familiarity with MCG guidelines Experience in handling fast-paced UM processes and adhering to strict turnaround times Fluency in Spanish, Bengali, or Mandarin is preferred but not mandatory