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Remote Utilization Review Specialist (RN/LPN)

Ampcus Inc - IT Consulting Services

Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires knowledge of managed care, strong communication skills, and the ability to handle confidential PHI while coordinating with medical directors and other teams. Remote work is offered nationwide. #J-18808-Ljbffr Ampcus Inc

Vacancy posted 5 days ago
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