Remote RN: Utilization Management & Medical Review

Arkansas Blue Cross · Workfromhome, United States

Arkansas Blue Cross and Blue Shield is seeking an Utilization Management Nurse to perform clinical review of prior approvals, network exceptions, benefit inquiries, inpatient admissions and outpatient procedures. The role evaluates medical necessity using evidence-based criteria and promotes cost containment through informed decision making.

The candidate should hold a Bachelor's degree in Nursing and an active RN license, with at least four years of clinical nursing experience in relevant