Minnesota Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse responsible for managing pre-claim prior authorization denials for pharmacy and medical benefits.

Key Responsibilities

Review and assess prior authorization pre-claim denials for clinical appropriateness and appeal potential

Prepare and submit clinical documentation and appeal letters to overturn denied authorizations

Analyze pre-claim denial patterns and recommend preventative strategies

Required Qualifications

Successful completion of an accredited Associate Degree in Nursing (ADN) program

RN licensure (NCLEX-RN) required prior to start date

2 years of experience in clinical practice, utilization or formulary management, prior authorization submission

Preferred : Bachelor's degree in Nursing