Offer summary
Qualifications:
Bachelor’s Degree in Nursing or equivalent, 3 years of experience in acute care/health insurance, 2 years with prior authorization/utilization review, Current unrestricted Registered Nurse license, CCM Certification preferred.
Key responsabilities:
- Evaluate and approve requested services for accuracy
- Manage medical necessity reviews and case monitoring
- Document information in health plan's UM system
- Identify referrals for care management support
- Collaborate with internal teams and external partners