Utilization Management RN
Created at: October 05, 2025 03:29
Company: Your IT Recruiter
Location: New York, NY, 10001
Job Description:
This is a remote position. The Utilization Management (UM) Nurse is responsible for conducting clinical reviews and assessing the medical necessity, appropriateness, and efficiency of healthcare services requested by providers and members. This role supports the health plan’s utilization management functions in alignment with clinical guidelines, plan benefits, regulatory requirements, and accreditation standards. The UM Nurse ensures the delivery of cost-effective, high-quality care for member…