Registered Nurse Medical Review Specialist

Job Summary

Conducting utilization reviews remotely, the full-time Registered Nurse Medical Review Specialist will assess medical necessity for hospital admissions and outpatient procedures while ensuring compliance with established standards and guidelines.

Key responsibilities

• Perform preadmission and concurrent reviews to determine medical necessity for hospital stays and outpatient services
• Communicate with healthcare providers and patients regarding utilization management requirements and decisions
• Document and report findings, ensuring timely processing of reviews and adherence to regulatory standards

Required qualifications

• Associate's degree in nursing; Bachelor's degree preferred
• Current unrestricted Registered Nurse licensure in the state of practice
• A minimum of 5 years of varied clinical nursing experience
• Proficiency in MS Office Suite (Word, Excel, PowerPoint)
• Knowledge of URAC standards and state certification requirements