Senior UM Review Nurse

📋 Description

• Gather medical information and perform medical necessity reviews per guidelines.
• Meet required decision timeframes and escalate to physician review.
• Write clear reviews for inpatient, outpatient and specialty requests.
• Use Oscar tools to investigate utilization reviews and assist with staffing.
• Act as SME and support nurse supervisors and precept new staff.
• Contribute to root cause analysis and process improvement.

🎯 Requirements

• Active, unrestricted RN license in the U.S. or compact multistate license per NLC.
• Associate degree and/or BSN in nursing.
• 2+ years utilization review experience.
• 2+ years healthcare experience.
• MCG experience.
• 1+ years clinical practice in acute care.

🎁 Benefits

• Medical, dental, and vision benefits.
• 11 paid holidays and paid sick time.
• 401(k) with company match and life/disability insurance.
• Paid wellness time and reimbursements.