Licensed Practical Nurse

To support effective healthcare delivery, the contract Georgia Licensed Med Management Nurse will review complex medical necessity cases, collaborate with healthcare providers, and contribute to quality improvement initiatives while working remotely with occasional onsite attendance. Key responsibilities Review and evaluate complex medical necessity requests using clinical guidelines and nursing judgment Collaborate with healthcare providers to gather and interpret clinical information for utilization management decisions Support discharge planning activities and promote quality member outcomes through effective care management Required qualifications Associate Degree in Nursing (ADN) required Active, unrestricted Registered Nurse (RN) license in applicable state(s) or U.S. territory Multi-state licensure required if providing services across multiple states Minimum 4 years of care management or case management experience Minimum 2 years of clinical, utilization review, or managed care experience