Utilization Management Nurse, RN

Overview

Role involves managing authorization requests and ensuring medical necessity compliance.

Ideal candidate should have RN licensure and experience in utilization management or medical billing.

Locations

• United States

Requirements

• Current RN license
• Experience in medical billing or managed care
• Knowledge of medical coding and healthcare terminology
• Strong communication skills
• Attention to detail
• Proficient in Microsoft Office

Responsibilities

• Handle authorization requests
• Review medical necessity and plan coverage
• Manage provider communications
• Ensure accurate data entry
• Coordinate with Case Management
• Escalate requests for physician review

Benefits

• Comprehensive insurance coverage
• 401(k) with employer match
• Health Savings Account
• Paid time off
• Employee Assistance Program