Utilization Management Nurse RN

A company is looking for a Utilization Management Nurse. Key Responsibilities Performs utilization review activities, including pre-certification, concurrent, and retrospective reviews according to guidelines Determines medical necessity of each request by applying appropriate medical criteria to first level reviews Reviews, documents, and communicates all utilization review activities and outcomes Required Qualifications Registered Nurse with a current license to practice in the state of employment Current compact RN Licensure to practice in applicable states 2+ years of experience in managed care, Utilization Review, or Case Management, or 5+ years nursing experience Relevant experience in UM process activities such as prior authorization or medical claims review Knowledge of medical terminology, ICD-9 / ICD-10, and CPT