Care Review Clinician I / UM

Job Title : Care Review Clinician I / UM

Location : 100% Remote

Duration : 3 Months+ (Possible Extension)

Schedule : Mon - Fri (Standard shift timing)

Position Summary :

• Must reside in one of the following states to be considered : FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI Ky Licensure ; UM experience preferred : For BH positions, may use Social Workers;
• The Utilization Review Nurse will work as part of the Utilization Management team, primarily responsible for inpatient medical necessity reviews, concurrent reviews, and prior authorization activities. The role ensures members receive the right care at the right time in the most appropriate setting, while maintaining compliance with state and federal regulations.

Key Responsibilities :