Utilization Review Nurse, RN

A company is looking for a Utilization Review Nurse, RN. Key Responsibilities Conduct assessments and reviews for medical necessity of treatment requests and plans Process outpatient and inpatient pre-certification requests and manage appeals for non-certification of services Collaborate with hospital staff for patient discharge and ensure proper referrals to case management and wellness programs Required Qualifications and Education Current RN license in the United States or U.S. territory 1+ years of clinical experience required Knowledge of medical claims and coding (ICD-10, CPT, HCPCS) Proficiency in Microsoft Office applications

Mar 22, 2025 - 05:03

A company is looking for a Utilization Review Nurse, RN. Key Responsibilities Conduct assessments and reviews for medical necessity of treatment requests and plans Process outpatient and inpatient pre-certification requests and manage appeals for non-certification of services Collaborate with hospital staff for patient discharge and ensure proper referrals to case management and wellness programs Required Qualifications and Education Current RN license in the United States or U.S. territory 1+ years of clinical experience required Knowledge of medical claims and coding (ICD-10, CPT, HCPCS) Proficiency in Microsoft Office applications