Utilization Management RN

A company is looking for a Utilization Management RN for a fully remote contract position. Key Responsibilities Conducts retrospective clinical reviews based on state and medical necessity criteria using InterQual guidelines Ensures timely processing of accounts according to payor guidelines and follows up on initial denials Maintains department productivity and quality measures while performing additional tasks as assigned Required Qualifications Active, unrestricted State Registered Nursing or Licensed Vocational Nursing license in good standing High School Diploma or equivalent required Completion of an accredited RN or LVN program required Bachelor's degree in nursing or a health-related field preferred Minimum of 3 years clinical practice experience and 2 years in utilization management or case management required

Feb 18, 2025 - 22:23

A company is looking for a Utilization Management RN for a fully remote contract position. Key Responsibilities Conducts retrospective clinical reviews based on state and medical necessity criteria using InterQual guidelines Ensures timely processing of accounts according to payor guidelines and follows up on initial denials Maintains department productivity and quality measures while performing additional tasks as assigned Required Qualifications Active, unrestricted State Registered Nursing or Licensed Vocational Nursing license in good standing High School Diploma or equivalent required Completion of an accredited RN or LVN program required Bachelor's degree in nursing or a health-related field preferred Minimum of 3 years clinical practice experience and 2 years in utilization management or case management required