New York Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Registered Nurse (remote).

Key Responsibilities

• Perform prior authorization reviews and make recommendations on workers' compensation compliance
• Analyze medical documentation to ensure appropriate utilization and adherence to treatment guidelines
• Identify and resolve discrepancies, denials, or disputed claims efficiently

Qualifications

• Minimum 3 years of utilization review/prior authorization experience focused on workers' compensation
• Experience interpreting medical treatment guidelines
• Knowledge of prior authorization processes and regulatory compliance for workers' compensation cases
• Proficiency in electronic prior authorization processing platforms
• Ability to work independently and meet deadlines in a remote setting