New3d ago
- Specialty: Utilization Review
- Job type: Full-time
- Salary: $75,000 – $95,000
- License states: Compact
Weekend shiftAppeals+2
Job details- Utilization Review
- Full-time
- $70,000 – $100,000
- License: Compact
- 3+ years
Job description
The Utilization Nurse Consultant uses clinical judgment to review prior authorization requests for medical necessity using MCG criteria. This is a remote role requiring an active RN license and 3+ years of clinical experience. Responsibilities include reviewing clinical documentation, applying criteria, and making coverage determinations. Salary range: $70,000–$100,000.
Key responsibilities
- Review prior authorization requests
- Apply MCG criteria for medical necessity
- Make coverage determinations
- Document decisions in system
What you bring
- Active RN license
- 3+ years clinical experience
- Knowledge of MCG or InterQual
- Strong clinical judgment
Tags
RemoteUtilization ReviewMCGCVS Health
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- Specialty: Utilization Review
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- Salary: $70,000 – $100,000
- License states: Compact
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- Specialty: Utilization Review
- Job type: Full-time
- Salary: $70,000 – $100,000
- License states: Compact
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