Minnesota Licensed Utilization Review Nurse

Job Summary

Collaborating with Care Management staff and healthcare providers, the part-time Minnesota Licensed Utilization Review Nurse will assess patient admissions, ensure accurate claims submission, and monitor the utilization of acute care services while working 40 hours every two weeks with a mix of day and evening shifts, including weekends, and the option to work from home after training.

Key responsibilities

• Conduct utilization review activities to determine appropriate levels of care for hospital admissions
• Coordinate with billing and claims departments to ensure accurate reimbursement processes
• Identify quality indicators and performance improvement opportunities in acute care services

Required qualifications

• Bachelor's Degree or higher in nursing
• Current Registered Nurse (RN) licensure in the State of Minnesota
• Minimum of 2 years of relevant clinical experience in utilization review, quality assurance, or case management
• Acute care clinical experience
• Knowledge of medical/legal issues and documentation in healthcare