Nurse Liaison I - Utilization Management & Quality Review - Remote
Health Care Service Corporation$70K – $126K per yearUnited States only
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Job Summary
This position is responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role supports clinical review activities requiring 5+ years of experience as a Nurse Reviewer or Clinical Reviewer. Responsibilities include assisting with benefit determinations, medical necessity reviews, benefit terminations, and process improvements while ensuring clinically sound and well-documented coverage decisions and compliance. Required Job Qualifications