Utilization Management Nurse

Working remotely in a full-time capacity, the Registered Nurse Utilization Management will manage complex reviews and processing of authorization requests for various medical services, ensuring compliance with regulatory standards while maintaining high-quality outcomes. Key responsibilities Independently conduct prospective, retrospective, and concurrent reviews for inpatient admissions and outpatient procedures Collaborate with management to ensure accuracy in documentation and compliance with Federal, State, and Regulatory requirements Facilitate safe discharge planning by coordinating with Health Partners, Care Managers, and Discharge Planners Required qualifications Bachelor of Science in Nursing or Master's Degree in Social Work, Counseling, or a related field 3+ years of work experience in a related job discipline Current, unrestricted Registered Nurse (RN), Social Work, or Clinical Counselor Licensure in state(s) of practice