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Utilization Management Nurse

Company: VirtualVocations
Location: Knoxville
Posted on: September 17, 2023

Job Description:

A company is looking for a Utilization Management Nurse.
Key Responsibilities:

Perform pre-service and post-service UM authorization reviews utilizing federal and state mandates
Work with non-clinical team to obtain additional clinical information, as needed
Approve requests that meet eligibility, benefit, and medical necessity criteria

Required Qualifications:

Active, Licensed Vocational Nurse, or Licensed Practical Nurse license
Minimum of 3 years of nursing in an acute or outpatient setting
Minimum of 2 years of UM experience in a managed care, payor environment
Experience with Medicare and Medicaid (not required, but highly desirable)
Experience with UM authorizations and appeals for DMEPOS (not required, but highly desirable)

Keywords: VirtualVocations, Knoxville , Utilization Management Nurse, Healthcare , Knoxville, Tennessee

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