Utilization Manager, Registered Nurse

About the Role

Join COPE Health Solutions as a Utilization Manager, Registered Nurse in United States.

Key Responsibilities

• Examines standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, level of care and lengths of stay.

• Performs prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting.

• Reviews requests for outpatient and inpatient admission; approves services or consults with medical directors when case does not meet medical necessity criteria.

Requirements

• wide trends that affect member eligibility and the need for issuance of Determination Notices Improves clinical and cost

• effective outcomes such as reduction of hospital admissions and emergency department visits through on

Benefits & Compensation

• Salary: $80K - $110K

Work Schedule

• Full-Time position.

• Remote position - work from anywhere.

• Day shift only - no nights.

This position offers day shifts only. Work with COPE Health Solutions in United States.