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Utilization Management Nurse Associate
Ref No.: 17-24366
Location: New Albany, Ohio

Summary:
  • The UM Nurse Associate performs medical necessity review in response to requests for prior authorization of outpatient services.
  • The UM Nurse Associate may be also receive incoming calls from Providers submitting requests for prior authorization of services, and make outbound calls to providers as necessary.       
 Required Qualifications:
  • LPN License Required.
  • Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration.
  • Collects information to support the process of rendering appropriate medical necessity/benefit and determinations.
  • Identifies members for referral opportunities to integrate with other products, services and/or programs Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations.
  • 2 years managed care experience.
  • 2 plus years clinical experience required