Job Description

We are hiringUS Registered Nurses (USRN)withUtilization Management (UM)experience to join our growing healthcare operations team inBGC. If you are looking to move into anon-bedside, corporate healthcare rolewhile still using your clinical expertise—this is for you.

Qualifications

  • Active USRN license
  • At least 6 months Utilization Management experience
  • At least 3 months clinical experience (hospital or clinical setting)
  • Experience in medical necessity review, authorizations, or care management is an advantage
  • Willing to work onsite in BGC (weekdays)

Role Overview

  • Review clinical documentation for medical necessity and coverage
  • Perform concurrent, retrospective, and/or prior authorization reviews
  • Apply evidence-based guidelines (e.g., InterQual, MCG)
  • Communicate with providers and internal care teams
  • E...

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