Licensed Utilization Review Nurse

Job Summary

Performing all aspects of the Utilization Review Process, the full-time Licensed Utilization Review Nurse will review records and requests, utilize evidence-based guidelines for authorization decisions, and document findings while working remotely.

Key responsibilities

• Conduct comprehensive reviews of medical records and requests for utilization review
• Write summaries and document determinations in the database for each completed review
• Establish collaborative relationships with clients, patients, and healthcare providers

Required qualifications

• Associate's or Bachelor's degree in Nursing
• Active and unencumbered RN license in one or more states
• 3 to 5 years of clinical practice experience or 2 years of case management and/or utilization review experience
• Experience with Workers' Compensation, short-term or long-term disability, or liability claims
• General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines