Registered Nurse Director of Utilization Review

Job Summary

Leading strategic initiatives, the full-time remote Registered Nurse Director of Utilization Review will manage utilization review functions, ensuring compliance and optimizing performance while collaborating with clinical and operational teams.

Key responsibilities

• Direct daily operations of utilization review, developing and implementing policies and processes
• Establish metrics and executive-level reporting for performance accountability and improvement
• Collaborate with revenue cycle leaders to reduce payer denials and streamline the appeals process

Required qualifications

• Master's degree in nursing or related field
• 5+ years of experience in nursing or utilization review
• 1+ years of experience in a leadership role
• Registered Nurse (RN) license
• Strong working knowledge of Epic; experience with XSOLIS preferred