Tennessee Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse. Key Responsibilities Collaborate with the PAC Medical Director on medical necessity decisions and care planning Act as a clinical resource for unlicensed staff and primary contact for post-acute facilities Authorize continued stays and ensure compliance with regulatory turnaround time standards Qualifications Current and unrestricted LPN or RN license Associate's Degree or Diploma in Nursing/Practical Nursing Minimum of 2 years of clinical experience in a clinical setting Experience in Utilization Management and knowledge of URAC & NCQA standards Familiarity with evidence-based care guidelines such as MCG/Milliman and Interqual

Apr 17, 2025 - 01:53

A company is looking for a Utilization Review Nurse. Key Responsibilities Collaborate with the PAC Medical Director on medical necessity decisions and care planning Act as a clinical resource for unlicensed staff and primary contact for post-acute facilities Authorize continued stays and ensure compliance with regulatory turnaround time standards Qualifications Current and unrestricted LPN or RN license Associate's Degree or Diploma in Nursing/Practical Nursing Minimum of 2 years of clinical experience in a clinical setting Experience in Utilization Management and knowledge of URAC & NCQA standards Familiarity with evidence-based care guidelines such as MCG/Milliman and Interqual