Utilization Management Nurse, RN

The Utilization Management Nurse is responsible for handling authorization requests, reviewing requests for medical necessity and plan coverage, managing provider communications, and ensuring accurate data entry of coding and provider information. This role involves inputting medical coding and provider information for authorization requests, ensuring completeness and accuracy of requests and medical records, and reviewing medical records and clinical guidelines to ensure medical necessity requirements are met. The nurse will escalate requests requiring physician review, coordinate with the Case Management team, and maintain knowledge of URAC standards.