West Virginia Licensed Utilization Review RN

A company is looking for a Utilization Review RN. Key Responsibilities Review and assess clinical information to support Utilization Management decisions Facilitate communication with payors to ensure authorization processes are patient-centered and timely Collaborate with interdisciplinary teams to manage concurrent denials and optimize reimbursement Required Qualifications Current unencumbered RN license in state of residency or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) Three years of healthcare clinical experience Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN) or Diploma; currently enrolled in a BSN program with completion within three years of hire is preferred Experience in medical management for Medicare and/or Medicaid populations is preferred Utilization Management experience is preferred

Apr 9, 2025 - 21:40

A company is looking for a Utilization Review RN. Key Responsibilities Review and assess clinical information to support Utilization Management decisions Facilitate communication with payors to ensure authorization processes are patient-centered and timely Collaborate with interdisciplinary teams to manage concurrent denials and optimize reimbursement Required Qualifications Current unencumbered RN license in state of residency or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) Three years of healthcare clinical experience Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN) or Diploma; currently enrolled in a BSN program with completion within three years of hire is preferred Experience in medical management for Medicare and/or Medicaid populations is preferred Utilization Management experience is preferred