Utilization Management Nurse (MLTC Focus) - Remote

Overview

We are seeking a Utilization Management Nurse specializing in Managed Long-Term Care (MLTC) to perform standard and expedited inpatient, outpatient, and custodial care clinical reviews for MLTC members.

In Short

• Conduct all standard and expedited UM clinical reviews for MLTC members.
• Manage the UM process, including clinical reviews and processing of denials.
• Participate in interdisciplinary team meetings and present cases for medical reviews.
• Meet productivity goals and maintain high performance standards.
• Perform reviews for all authorization types under the MLTC benefit package.
• Adhere to fast turnaround timeframes for requests.
• Meet daily case review expectations with a target of 30 cases per day.

Requirements

• 1-2 years in Utilization Management with a focus on Medicaid/MLTC members.
• Active New York State LPN or RN license required.
• Strong computer skills and ability to learn new systems.
• Experience in fast-paced UM processes and strict timeframes.
• Experience in providing verbal notifications of denials.
• Fluency in Spanish, Bengali, or Mandarin preferred.

Benefits

• Opportunity to be part of a dynamic team.
• Contribute to quality care for MLTC members.
• Work in a fast-paced environment.