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Job Summary: The Utilization Management (UM) PHRN is responsible for the review, processing, and resolution of UM cases. The role ensures timely and clinically sound UM review, upholding member rights and health plan obligations under commercial and CMS regulations. The UM PHRN also supports case documentation and contributes to the quality and compliance targets of the payer program.

Qualifications:

•College Graduate (BSN)

•With an active Nursing License