Utilization Management RN

Become a part of our caring community The Utilization Management Nurse, National Medicaid Clinical Operations is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for inpatient services. This role ensures that all requests meet medical necessity criteria and comply with health plan policies and regulatory requirements. The RN Review Nurse works closely with healthcare providers, interdisciplinary teams, and nonclinical staff to facilitate timely and appropriate care for members. This role operates autonomously within their scope of practice, making independent clinical decisions. This role will report directly to the Manager, Utilization Management.…