Registered Nurse Utilization Management

A company is looking for a Clinical Registered Nurse - Utilization Management - Remote.

Key Responsibilities

Manage clinical denials and perform medical necessity reviews based on various guidelines

Document claims and appeals information accurately in tracking systems

Identify denial patterns and escalate potential risks to stakeholders

Required Qualifications

Registered Nurse (RN) educational background

2-3 years of clinical and / or utilization management experience with managed health care plans

3 years of experience in health care revenue cycle or clinic operations

Experience in utilization management, including clinical appeals and precertification

Intermediate knowledge of Microsoft Office (Excel, Word, Outlook)