Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse. Key Responsibilities Conducts prospective, concurrent, and retrospective utilization reviews for inpatient and outpatient services Evaluates member needs at the time of inpatient admission and prioritizes cases to meet CMS standards Maintains accurate records of utilization review activities and ensures compliance with regulations Required Qualifications Licensed RN or LPN required Minimum of two to three years of varied clinical experience Managed care experience preferred Equivalent combination of education, training, and experience accepted InterQual experience helpful

Mar 25, 2025 - 21:07

A company is looking for a Utilization Review Nurse. Key Responsibilities Conducts prospective, concurrent, and retrospective utilization reviews for inpatient and outpatient services Evaluates member needs at the time of inpatient admission and prioritizes cases to meet CMS standards Maintains accurate records of utilization review activities and ensures compliance with regulations Required Qualifications Licensed RN or LPN required Minimum of two to three years of varied clinical experience Managed care experience preferred Equivalent combination of education, training, and experience accepted InterQual experience helpful