Utilization Management Nurse (Remote)

The Utilization Management Nurse is responsible for managing requests, providing a multi-faceted approach to managing requests for medical services while ensuring the services are medically appropriate and necessary. This role requires utilizing evidence-based clinical guidelines and input from healthcare providers to achieve high-quality, cost-efficient medical outcomes for patients requiring in-patient care and outpatient procedures. Responsibilities include assessing each request for medical services, adhering to clinical guidelines, collaborating with healthcare providers, communicating with stakeholders, ensuring regulatory compliance, monitoring utilization trends, and participating in quality improvement initiatives. Additional duties are assigned as needed.