Maine Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse - Remote.

Key Responsibilities

Review prior authorization requests for medical necessity and manage medical claims disputes

Coordinate transitions of care and collaborate with healthcare providers to promote effective resource utilization

Document reviews and decisions according to compliance requirements and participate in quality initiatives

Required Qualifications

3+ years of clinical nursing experience as an RN, preferably in a hospital setting

Utilization management experience in a health plan UM department

Compact RN License

Certification in managed care nursing or care management desired (CMCN or CCM)

Knowledge of applicable regulatory guidelines and compliance standards