Utilization Review Nurse - RN

A company is looking for a Part-Time Utilization Review Nurse - RN. Key Responsibilities Provide professional assessment and review for the medical necessity of treatment requests and plans under the supervision of a registered nurse (RN) Conduct first level reviews for outpatient and inpatient pre-certification requests for medical appropriateness and manage post-service reviews Ensure proper referrals and documentation for denial authorizations and appeals, while maintaining confidentiality and utilizing medical guidelines Required Qualifications Current RN license in the United States or U.S. territory 1+ years of clinical experience required Knowledge of medical claims and ICD-10, CPT, HCPCS coding Proficiency in software applications including Microsoft Word, Excel, PowerPoint, and Outlook

Mar 13, 2025 - 23:27

A company is looking for a Part-Time Utilization Review Nurse - RN. Key Responsibilities Provide professional assessment and review for the medical necessity of treatment requests and plans under the supervision of a registered nurse (RN) Conduct first level reviews for outpatient and inpatient pre-certification requests for medical appropriateness and manage post-service reviews Ensure proper referrals and documentation for denial authorizations and appeals, while maintaining confidentiality and utilizing medical guidelines Required Qualifications Current RN license in the United States or U.S. territory 1+ years of clinical experience required Knowledge of medical claims and ICD-10, CPT, HCPCS coding Proficiency in software applications including Microsoft Word, Excel, PowerPoint, and Outlook