Oregon Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse to evaluate clinical service requests and ensure appropriate care for members.

Key Responsibilities

• Conduct clinical assessments to determine medical necessity and appropriateness of service requests
• Collaborate with interdisciplinary teams to support integrated care and safe transitions across care settings
• Maintain compliance with regulatory guidelines and participate in quality improvement initiatives

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license in Oregon or a compact state
• Graduation from an accredited nursing program
• Minimum of five (5) years of direct patient care experience in a clinical setting
• Proficient in InterQual criteria and utilization management software
• Strong working knowledge of regulatory compliance standards, including NCQA and OHP