New York Licensed Utilization Management Nurse

Job Description - New York Licensed Utilization Management Nurse

A company is looking for a Utilization Management Nurse (MLTC Focus) to perform clinical reviews for Managed Long-Term Care members. Key Responsibilities Conduct standard and expedited UM clinical reviews for inpatient, outpatient, and custodial care services Manage the UM process, including clinical reviews, denials, and notifications to members and providers Participate in interdisciplinary team meetings and present cases for medical reviews Required Qualifications 1-2 years of experience in Utilization Management with a focus on Medicaid/MLTC members Active New York State LPN or RN license Strong computer skills and familiarity with MCG guidelines Experience handling fast-paced UM processes with strict adherence to turnaround times Fluency in Spanish, Bengali, or Mandarin is preferred but not mandatory