UM Nurse
Enterprise Engineering, Inc. · Posted Nov 9, 2026
- Remote, United States
- Remote
- Contract
- 2+ years
UM Nurse responsible for medical necessity reviews and care coordination for a population of members, ensuring quality and cost-effective outcomes.
Responsibilities
- Perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members
- Review cases for medical necessity and apply appropriate clinical criteria including Medicare, Medicaid/Medi-cal, InterQual, Milliman, and Health Plan specific guidelines
- Collaborate with the Medical Director to ensure integrity of adverse determination notices
- Ensure discharge planning is timely and communicated to transition of care teams
- Meet or exceed productivity targets
Requirements
- Associate's degree in Nursing