Utilization Review Nurse: Care Optimization & Compliance
American Health Communities
American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., seeks a Utilization Review Nurse. You will assess the medical necessity and quality of care, conduct UM reviews, and collaborate with the Clinical Services Department to ensure compliant member care. Requirements include an active RN license and 1+ year in utilization management, with knowledge of InterQual/MCG guidelines and Medicare rules. Remote options are not listed; location is Franklin, TN. #J-18808-Ljbffr American Health Communities
Vacancy posted 3 days ago
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