New Mexico Licensed Utilization Nurse
Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025
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Job Description:
A company is looking for a Utilization Management Nurse
Specialist.
Key Responsibilities
Conduct clinical reviews to ensure services meet clinical criteria
and are delivered appropriately
Validate and interpret medical documentation using evidence-based
criteria, and consult with medical directors on cases
Perform retrospective medical claims audits and streamline the
prior authorization process to enhance patient outcomes
Required Qualifications
Active New Mexico Nursing license
3-5 years of nursing experience and 1-3 years in utilization
management, prior authorization, or case management
Strong knowledge of healthcare terminology, clinical guidelines,
and insurance authorization processes
Proficiency with EHR and case management software
For LPNs: similar experience and qualifications as above will be
considered
Keywords: VirtualVocations, Tustin , New Mexico Licensed Utilization Nurse, Healthcare , Vista, California
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