Utilization Review RN
A company is looking for a Utilization Review RN. Key Responsibilities Perform prospective, concurrent, and retrospective reviews of various medical services to ensure medical necessity and appropriate care levels Analyze and respond to retrospective review requests and appeals in compliance with regulatory standards Coordinate discharge planning and communicate with internal and external entities regarding patient care needs Required Qualifications Current unrestricted Registered Nurse license Minimum of 2 years of clinical experience, including acute care and utilization review Health insurance plan experience or managed care environment preferred Certification in Case Management preferred or progress toward certification Demonstrated clinical knowledge related to healthcare delivery processes
A company is looking for a Utilization Review RN.
Key Responsibilities
Perform prospective, concurrent, and retrospective reviews of various medical services to ensure medical necessity and appropriate care levels
Analyze and respond to retrospective review requests and appeals in compliance with regulatory standards
Coordinate discharge planning and communicate with internal and external entities regarding patient care needs
Required Qualifications
Current unrestricted Registered Nurse license
Minimum of 2 years of clinical experience, including acute care and utilization review
Health insurance plan experience or managed care environment preferred
Certification in Case Management preferred or progress toward certification
Demonstrated clinical knowledge related to healthcare delivery processes
