Registered Nurse - Utilization Management I

The Registered Nurse - Utilization Management I supports specific utilization management program functions within the Clinical Operations department, focusing on Benefit Management, Benefit Review, Appeals and Grievances, and Health Related Services. This remote role involves determining medically appropriate services, applying clinical-based criteria for decision-making, and managing medical expenses to support member healthcare needs. The position is primarily on the Appeals and Grievances team and requires collaboration with Medical Directors and clinical support staff to ensure compliance with state and federal guidelines.