Georgia Licensed Utilization Review Nurse
Job Summary
To support patient care initiatives, the full-time Georgia Licensed Utilization Review Nurse will conduct thorough medical necessity reviews and collaborate with healthcare teams while working remotely.
Key responsibilities
- Conduct comprehensive medical necessity reviews using InterQual Criteria and ensure compliance with regulatory requirements
- Communicate effectively with provider teams regarding patient class designations and medical necessity determinations
- Document and manage utilization reviews, including identifying avoidable delays and following denial workflows
Required qualifications
- Associate degree in nursing
- Minimum of 5 years of recent acute hospital experience or 2 years of utilization review experience
- Valid, active unencumbered Registered Nurse license approved by the Georgia Licensing Board
- Ability to meet quality and productivity expectations and complete yearly competencies
- Experience with InterQual Level of Care Criteria is preferred
Complete Job Description
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