Utilization Review Registered Nurse
A company is looking for a Utilization Review Nurse to join their Clinical Review team. Key Responsibilities Complete medical necessity and level of care reviews using clinical judgment and guidelines Obtain necessary information to assess a member's clinical condition and apply evidence-based guidelines Refer members for further care engagement and ensure compliance with applicable laws and regulations Required Qualifications Active, unrestricted RN licensure from the United States or compact multistate RN license Associate Degree in Nursing or graduate of an accredited school of nursing Ability to obtain additional state licenses as needed 1+ year of utilization review experience in a managed care setting 2+ years of clinical experience, including at least 1 year in an acute care setting
A company is looking for a Utilization Review Nurse to join their Clinical Review team.
Key Responsibilities
Complete medical necessity and level of care reviews using clinical judgment and guidelines
Obtain necessary information to assess a member's clinical condition and apply evidence-based guidelines
Refer members for further care engagement and ensure compliance with applicable laws and regulations
Required Qualifications
Active, unrestricted RN licensure from the United States or compact multistate RN license
Associate Degree in Nursing or graduate of an accredited school of nursing
Ability to obtain additional state licenses as needed
1+ year of utilization review experience in a managed care setting
2+ years of clinical experience, including at least 1 year in an acute care setting
