West Virginia Licensed RN

Collaborating with the Medical Director, the full-time Utilization Management RN will drive care variance reduction, ensure timely discharges, and refer members to appropriate resources while working remotely. Key responsibilities Assist in building and implementing care management review processes, including Prior Authorization and Concurrent Reviews Ensure interventions are collaborative and focus on maximizing member healthcare outcomes Educate stakeholders to improve processes and strengthen network relationships Required qualifications Current Registered Nurse license issued by West Virginia or a multi-state RN license through the enhanced Nurse Licensure Compact (eNLC) Three years of healthcare clinical experience Bachelor's Degree in Nursing or Associate of Science in Nursing; currently enrolled in a BSN program with completion within three years is acceptable Experience in Medical Management for Medicare and/or Medicaid populations Utilization Management experience