Missouri Licensed Utilization Review RN

A company is looking for a Utilization Review RN to collaborate with healthcare teams to ensure patient-focused care and appropriate resource utilization. Key Responsibilities Collaborate with physicians and the multidisciplinary team to monitor patient progress and ensure high-quality care Conduct concurrent medical record reviews for medical necessity and appropriateness of inpatient or observation services Provide education and resources on utilization and coverage determinations to physicians and payers Required Qualifications, Training, and Education Graduate of an accredited school of nursing Preferred: Bachelor's of Nursing with knowledge of InterQual Level of Care Criteria and/or Milliman Care Guidelines Minimum of 3 years of hospital experience required Current RN License active in the state of Missouri Preferred: Certified Case Manager

Mar 19, 2025 - 23:35

A company is looking for a Utilization Review RN to collaborate with healthcare teams to ensure patient-focused care and appropriate resource utilization. Key Responsibilities Collaborate with physicians and the multidisciplinary team to monitor patient progress and ensure high-quality care Conduct concurrent medical record reviews for medical necessity and appropriateness of inpatient or observation services Provide education and resources on utilization and coverage determinations to physicians and payers Required Qualifications, Training, and Education Graduate of an accredited school of nursing Preferred: Bachelor's of Nursing with knowledge of InterQual Level of Care Criteria and/or Milliman Care Guidelines Minimum of 3 years of hospital experience required Current RN License active in the state of Missouri Preferred: Certified Case Manager