Offer summary
Qualifications:
Graduate from an Accredited School of Nursing, 2 – 4 years related experience, LPN or RN state licensure required, Knowledge of Medicare and Medicaid regulations preferred, Knowledge of utilization management processes preferred.
Key responsabilities:
- Perform medical necessity reviews of authorization requests
- Coordinate with healthcare providers and interdepartmental teams
- Escalate requests to Medical Directors as necessary
- Document and maintain member clinical information for compliance
- Provide education on utilization processes to improve care quality