Registered Nurse Clinical Care Reviewer

A company is looking for a Clinical Care Reviewer in Utilization Management. Key Responsibilities Complete medical necessity reviews for inpatient and outpatient services Utilize clinical judgment to evaluate requests and ensure appropriate service approvals Maintain knowledge of relevant laws, regulations, and policies while applying clinical judgment Required Qualifications, Training, and Education Must have Registered Nurse or compact state licensure Associate's Degree required; Bachelor's Degree in Nursing preferred 3+ years of clinical practice experience as a RN in relevant settings 1+ years of Utilization Management experience preferred Proficient in MS Office and electronic medical record systems

Feb 27, 2025 - 20:19

A company is looking for a Clinical Care Reviewer in Utilization Management. Key Responsibilities Complete medical necessity reviews for inpatient and outpatient services Utilize clinical judgment to evaluate requests and ensure appropriate service approvals Maintain knowledge of relevant laws, regulations, and policies while applying clinical judgment Required Qualifications, Training, and Education Must have Registered Nurse or compact state licensure Associate's Degree required; Bachelor's Degree in Nursing preferred 3+ years of clinical practice experience as a RN in relevant settings 1+ years of Utilization Management experience preferred Proficient in MS Office and electronic medical record systems