Job Description & Requirements
Utilization Review - Managed Care Nurse
Looking for RN's who demonstrate critical thinking skills, who follow outlined processes and preferably have previous UM experience. This Role is strictly Utilization Management in nature. RN's review authorizations (that cannot be completed at the LPN PA Coordinator level) and clinical information and compare this to Optima policy or Milliman Care Guideline criteria, collaborate with Optima Medical Director to make decision determinations, key in data and utilize multiple computer programs.