Registered Nurse Utilization Review

Collaborating with the Medical Director, the full-time Registered Nurse Utilization Review will manage care variance reduction, ensure timely discharges, and refer members to appropriate resources while working remotely. Key responsibilities Assist in building and implementing care management review processes consistent with industry standards Collaborate with the medical management team to enhance healthcare outcomes for members through coaching and case management interventions Educate stakeholders to improve processes and strengthen network relationships Required qualifications Current Registered Nurse license issued by the state or multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC) Three years of healthcare clinical experience Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN); currently enrolled in a BSN program with completion within three years of hire is preferred Experience in Medical Management for Medicare and/or Medicaid populations Utilization Management experience is a plus