Utilization Review Nurse

3 weeks ago


Albuquerque, New Mexico, United States Mitchell Martin Inc Full time
Our client, a member owned health insurance company, is seeking a Utilization Review Nurse

Location: Albuquerque, NM

Position Type: Contract

Job Responsibilities and Requirements:
  • This position is responsible for performing initial and annual NFLOC (Nursing Facility Level of Care) reviews including LTSS services.
  • UM Nurse serves as liaison between providers and Care Coordination Division.
  • This position conducts NFLOC reviews, service requests review, verifies eligibility, determines benefit levels in accordance to contract guidelines.
  • identifies and reports cases, and provides information regarding utilization management requirements and operational procedures to Care Coordinators, providers and facilities. New Mexico Nursing License
  • RN or LPN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
  • UMCM Coordinator Position will start remote.
  • The client will issue equipment.
  • Candidate must have high speed internet, smartphone, and comfortable place to work.
  • RN/LPN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.


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