Oregon Licensed Utilization Review Nurse

Job Summary

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

Key Responsibilities

• Monitor utilization practices from preadmission to discharge to ensure cost-effective resource use and quality patient care
• Conduct reviews of medical records to verify documentation meets medical necessity criteria according to regulatory guidelines
• Collaborate with care team members to improve documentation accuracy and manage admission status

Required Qualifications and Education

• Registered Nurse (RN) with a minimum of 2 years of experience in utilization review in an acute care setting
• Experience with Epic and InterQual systems
• Knowledge of payor policies for medical necessity criteria regarding observation and inpatient care
• Able to conduct a minimum of 20 case reviews per shift after training
• Availability to work between 8am and 4pm PST, including one weekend day every 4-5 weeks