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Virginia Licensed Utilization Review Nurse
A company is looking for a Utilization Review Nurse for weekend shifts in a remote capacity. Key Responsibilities Conduct prior authorization, inpatient, concurrent, and retrospective reviews Review provider requests for services requiring authorization and ensure compliance with medical policies Facilitate care coordination and discharge planning while managing appeals for denied services Required Qualifications and Education Registered Nurse (RN) License (Compact) required Bachelor's Degree in Nursing preferred 2-3 years of acute care clinical experience required Previous Utilization Review experience is a plus Experience with InterQual or Milliman preferred; knowledge of NCQA is advantageous
A company is looking for a Utilization Review Nurse for weekend shifts in a remote capacity.
Key Responsibilities
Conduct prior authorization, inpatient, concurrent, and retrospective reviews
Review provider requests for services requiring authorization and ensure compliance with medical policies
Facilitate care coordination and discharge planning while managing appeals for denied services
Required Qualifications and Education
Registered Nurse (RN) License (Compact) required
Bachelor's Degree in Nursing preferred
2-3 years of acute care clinical experience required
Previous Utilization Review experience is a plus
Experience with InterQual or Milliman preferred; knowledge of NCQA is advantageous