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 compliance with regulations
• Conduct utilization reviews, evaluate clinical information, and communicate findings to payors regarding medical necessity
• Participate in data collection and performance improvement activities to enhance service delivery and patient outcomes

Required Qualifications, Training, and Education

• Registered Nurse (RN) with a minimum of 2 years of experience in utilization review in an acute care setting
• Experience working with Epic and reviewing payor policies for medical necessity criteria
• Preferred Bachelor's degree in Nursing
• Preferred certifications: Certified Case Manager (CCM) or Accredited Case Manager (ACM)
• Able to conduct a minimum of 20 reviews per shift after training and work primarily between 8am and 4pm PST