Utilization Review Nurse

Candidates must reside in Florida, Georgia, Kentucky, or Ohio. A Bachelor's degree and RN credentials are required, along with at least 5 years of direct patient care experience, preferably in a hospital setting. A minimum of 3 years of utilization review experience in a health plan, managed care, or TPA environment is necessary. Proficiency with Milliman Care Guidelines (MCG) and experience in medical billing/coding within either a provider or payor setting are essential. Strong written communication, critical thinking, problem-solving, and cross-functional collaboration skills are also required. Prior authorization experience is strongly preferred.