New York Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse.

Key Responsibilities

• Review planned, in-process, or completed health care services for medical necessity and effectiveness
• Collaborate with physician peer reviewers and medical directors to determine coverage of requested services
• Maintain accurate documentation and support quality and performance improvement initiatives

Required Qualifications

• Current unrestricted NYS RN license
• BSN required; advanced degree preferred
• 2+ years of utilization review experience at a Managed Care Organization or Health Plan
• Working knowledge of Medicaid and/or Medicare regulations and coverage guidelines
• Inpatient experience required; MLTC and Hospital/SNF experience preferred