Utilization Management Nurse: Optimize Care

Wollborg Michelson Recruiting; Little Rock (AR); On-site; USD 60,000 - 90,000; Full time

Job summary

Wollborg Michelson Recruiting seeks an experienced Registered Nurse to perform medical necessity reviews for inpatient and outpatient services, ensuring compliance with regulatory requirements and cost-effective care.

The role requires strong nursing judgment, excellent communication, and the ability to manage multiple requests within standards. Active RN license in the applicable state and at least four years of clinical nursing experience are required.

Qualifications

• Active, unrestricted RN license in the applicable state.
• At least four years of clinical nursing experience in medical-surgical, surgical, intensive care, or critical care nursing.
• Experience in utilization management or medical review preferred.
• Bachelor of Science in Nursing preferred.
• Skill proficiency with Microsoft Word, Excel, Outlook, keyboarding, and multiple computer systems.

Responsibilities

• Review inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgical requests for medical necessity.
• Document relevant clinical information and organize determination requests according to applicable mandates and standards.
• Promote appropriate care, quality outcomes, accessibility, and cost-effective treatment.
• Collaborate with healthcare providers and internal teams to support appropriate service levels and care coordination.
• Process incoming and outgoing calls and queues efficiently within required timeframes.
• Practice nursing within the scope of licensure and follow applicable policies, procedures, regulations, and utilization review standards.
• Make objective, evidence-based decisions that support compliance, appropriate levels of care, and patient safety.
• Maintain current knowledge of medical and surgical procedures, healthcare services, products, medications, and healthcare delivery trends.
• Perform other duties as assigned.

Skills

Nursing expertise

Clinical decision making

Communication skills

Attention to detail

Multitasking

Education

RN license

BSN preferred

Tools

MS Word

Excel

Outlook

EMR systems

Job description

Wollborg Michelson Recruiting seeks an experienced Registered Nurse to perform medical necessity reviews for inpatient and outpatient services, ensuring compliance with regulatory requirements and cost-effective care.

The role requires strong nursing judgment, excellent communication, and the ability to manage multiple requests within standards. Active RN license in the applicable state and at least four years of clinical nursing experience are required.