Utilization Review RN

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 a compact multistate unrestricted RN license Associate Degree in Nursing or graduation from an accredited nursing program 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

Mar 12, 2025 - 20:44

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 a compact multistate unrestricted RN license Associate Degree in Nursing or graduation from an accredited nursing program 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