Utilization Management Correspondence RN

**Role Overview**

Under the direction of the Utilization Management Operations Administrative Supervisor, the Utilization Management (UM) Correspondence Registered Nurse (RN) is responsible for creation, writing, editing and completion of all utilization management review adverse decision notices and any additional informational letters in accordance with the appropriate state/plan requirements, within required timeframes.

The UM Correspondence RN has oversight of behavioral and physical health approval and denial letters for Medicaid, Medicare, and the Exchange. In this role, you will use regulatory, accreditation, and departmental standards and apply medical health benefit policy and medical management guidelines to ensure letters provide the appropriate justification in authorizing services and appropriately deny services when guidelines are not met. The UM Correspondence RN will maintain current knowledge and understanding of the laws, regulations, DHS/NCQA requir...