Utilization Management Nurse: Drive Quality, Cost-Effective Care

MyTruAdvantage; Columbus (IN); On-site; USD 65,000 - 90,000; Full time

Job summary

MyTruAdvantage is seeking an Utilization Management Nurse in Columbus, IN. This full-time, exempt role requires a licensed RN to perform prospective, concurrent, and retrospective reviews to ensure appropriate, evidence-based utilization of services.

You will interact with members, providers, and the care team to reach timely medical-necessity determinations while maintaining policy compliance and accurate documentation. Strong MS Office skills are essential, and prior UM experience is preferred.

Qualifications

• Licensed Registered Nurse with a current, unrestricted license.
• Prior utilization management or health-plan experience preferred.
• Proficient in Microsoft Office (Outlook, Word, Excel).

Responsibilities

• Pre-service, concurrent, and post-service review of medical necessity.
• Review enrollee records and apply guidelines from SIHO and CMS.
• Document reviews accurately in the designated system.
• Collaborate with care team to ensure timely medical necessity decisions.
• Support quality improvement initiatives and data reporting.

Skills

Registered Nurse

UM experience

Time management

Communication skills

MS Office

Education

RN license

Tools

Outlook

Word

Excel

Job description

MyTruAdvantage is seeking an Utilization Management Nurse in Columbus, IN. This full-time, exempt role requires a licensed RN to perform prospective, concurrent, and retrospective reviews to ensure appropriate, evidence-based utilization of services.

You will interact with members, providers, and the care team to reach timely medical-necessity determinations while maintaining policy compliance and accurate documentation. Strong MS Office skills are essential, and prior UM experience is preferred.