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California Licensed Utilization NurseVirtualVocations • Philadelphia, Pennsylvania, United States
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California Licensed Utilization Nurse

California Licensed Utilization Nurse

VirtualVocations • Philadelphia, Pennsylvania, United States
7 days ago
Job type
  • Full-time
Job description
A company is looking for a Utilization Management Nurse - Remote. Key Responsibilities Conducts clinical reviews for appropriate utilization of medical services using medical necessity criteria Documents clinical reviews and decisions in the care management system accurately and timely Collaborates with the Medical Management team for care coordination and prepares clinical information for case reviews Required Qualifications Current unrestricted Registered Nurse (RN) license in state of residence 3+ years of clinical nursing experience in an acute care hospital or LTAC setting 1+ years of Utilization Management experience in a hospital or insurance setting Experience applying Medicare and/or Medicaid guidelines Experience with Milliman (MCG) or InterQual guidelines
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California Licensed Utilization Nurse • Philadelphia, Pennsylvania, United States

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